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THE   INSANE 
IN    FOREIGN    COUNTRIES 


Gentle  as  angel's  ministry 

The  guiding  hand  of  love  should  be, 

Which  seeks  again  those  chords  to  bind 

Which  human  woe  hath  rent  apart — 
To  heal  again  the  wounded  mind, 

And  bind  anew  the  broken  heart. 

Whittier. 


THE   INSANE 


IN 


FOREIGN  COUNTRIES 


WILLIAM    P.  LETCHWORTH 

PKESIDENT    OK    THE    NH:\V    YORK    STATE    lif)AKl)    OK    CHAKIllKS 


NEW  YORK  &  LONDON 

G.    P.    PUTNAM'S    SONS 

(Tlje  llincluvbockcr  ^Ircss 

1889 


Copyright  uy 
WILLIAM    P.  LETCHWORTH 


Press  of 

G.  P.  Pitnam's  Sons 

New  York 


TO 

HIS   EXCELLENCY 

DAVID    13.     HILL 

GOVERNOR   OF    THE   STATE   OF    NEW    YORK 

AND    TO 

MY   ASSOCIATE    COMMISSIONERS   OF 
THE    NEW    YORK    STATE    BOARD    OF   CHARITIES 

THIS 
VOLUME   IS   RESPECTFULLY    DEDICATED 


CONTENTS 


CHAPTER  PAGE 

I.  Introductory  and  Retrospective         ,         .         .  i 

II.  England 15 

III.  Scotland  .........  109 

IV.  Ireland 172 

V.  Continental  Countries          .....  194 

VI.  The  Colony  of  Gheel     ......  239 

VII.  The  Provincial   Insane   Asylum   of  Alt-Scher- 

BiTZ        .........  279 

VIII.  Resume 293 

Index •         •         •  3^5 


LIST  OF  ILLUSTRATIONS 


PiNEL  A  LA  SaLPETRIERE 

Circulating  Swing    . 
Bands  and  Chains 
NoRRis  IN  Chains 
Day-room,  Brookwood 
Cottage  Hospital,  Brookwood 

DiNING-HALL,  PrESTWICH     . 

Infirmary  Ward,  Prestwich     . 
Convalescent  Ward,  Prestwich 
Day-room,  Prestwich 
Burning  an  Insane  Woman  as  a  Witch 
Taking  Lunatics  to  Dublin 
Belgian  Cage     ..... 

Plan  of  the  Colony  of  Fitz-James  . 
The  Church  of  St.  Dymphna    . 
Plan    of  the  Provincial  Insane  Asylum,  A 
BITZ        ...... 

Reception  Station,  Alt-Scherbitz 

Observation  Station,  Alt-Scherbitz 

Detention  House,  Alt-Scherbitz    . 

Villa  for  Patients,  Alt-Scherbitz 

Villa  for  Third-class  Patients,  Alt-Scherbitz 


Fro)itispiece 

9 

lO 

19 

76 

78 

94 

96 

98 

. 

100 

. 

no 

173 

197 

233 

240 

ILT-SCHER- 

280 

282 

284 

286 

2S8 

JITZ     . 

290 

PREFACE. 

The  following  pages  are  the  outcome  of  an  investigation  of 
foreign  charitable  institutions,  pursued  without  interruption 
through  seven  months,  during  which  time  special  attention 
was  given  to  the  various  kinds  of  provision  made  for  the  in- 
sane poor.  The  information  thus  collected  is  now  published, 
in  the  hope  of  furthering  the  elucidation  of  a  subject  which 
materially  concerns  not  only  the  State  as  a  whole,  but  each 
one  of  its  citizens. 

For  the  purpose  of  securing  fulness  as  well  as  accuracy, 
stenographic  notes  of  visitations  and  interviews  were  made. 
By  this  means  valuable  opinions,  expressed  by  distinguished 
specialists  with  whom  the  treatment  of  the  mentally  diseased 
has  been  a  life-long  study,  have  been  carefully  recorded. 
Avoiding,  as  far  as  possible,  medical  theories  and  contro- 
versies, the  writer  has  striven  to  convey  the  results  of  his 
observations  in  plain,  untechnical  language.  His  aim 
throughout  this  whole  inquiry  has  been  to  ascertain,  from 
a  practical  point  of  view,  what  are  the  most  advanced, 
the  most  humane,  and  the  most  economical  methods  of 
caring  for  the  insane. 

I  feel  it  a  pleasant  duty  to  gratefully  acknowledge  the 
courtesies  invariably  extended  to  me  by  officials  of  different 
ranks  in  the  countries  visited.  In  many  institutions  consid- 
erable time  was  spent  in  making  examinations,  and  the 
numerous  details  considered  made  the  task  of  imparting 
information  tedious ;  but  a  generous  spirit  was  everywhere 
shown  to  meet  the  object  of  my  visit.     To  the  permanent 


PREFA  CE. 


Secretary  of  the  English  Local  Government  Board,  to  the 
Commissioners  and  Secretaries  of  the  English  and  Scotch 
Boards  of  Lunacy,  and  to  the  Superintendents  of  the  vari- 
ous asylums  inspected,   I    am  under  special  obligations. 


The  publication  of  this  work,  most  of  the  material  for  which  was  collected 
a  few  years  since,  has  been  delayed  in  consequence  of  a  pressure  of  public 
duties.  Meanwhile,  however,  correspondence  has  been  maintained  with 
superintendents  of  many  of  the  institutions  visited,  and  information  kindly 
furnished  by  them,  and  the  latest  that  could  be  obtained  from  other  official 
sources  are  herein  embodied. 

W.  P.  L. 
Glen  Iris, 

Portageville  P.  O.,  N.  Y., 
1888. 


INSANE    IN    FOREIGN    COUNTRIES. 


CHAPTER  I. 
INTRODUCTORY  AND   RETROSPECTIVE. 

IN  this  age  of  high-pressure  living,  there  is  perhaps  no  sub- 
ject of  more  general  or  more  urgent  interest  than  that 
of  insanity  in  its  relations  to  the  State.  No  reflecting  mind 
can  be  indifferent  to  the  question  of  making  proper  public 
provision  for  the  treatment  and  care  of  those  afflicted  with 
an  insidious  disease  from  which  no  measure  of  intellectual 
or  physical  strength  or  worldly  prosperity  affords  any  certain 
immunity — a  disease,  which,  prone  to  feed  upon  excitement, 
finally  transforms  the  noblest  faculties  of  our  race  into  a 
wreck  so  appalling,  that  in  its  contemplation  the  human 
intelligence  becomes  bewildered  and  dismayed.  At  no  time 
in  the  history  of  civilization  has  the  importance  of  this  sub- 
ject been  more  fully  acknowledged  ;  and  probabK-  at  no 
time  have  influences  contributory  to  mental  derangement 
been  more  powerful  than  they  are  to-day.  In  America, 
where,  from  a  variety  of  causes,  there  is  so  much  mental  ac- 
tivity, and  where  a  condition  of  great  prosperity  attracts  the 
surplus  population  of  Europe,  there  are  obvious  reasons  why 
the  various  problems  relating  to  insanity  should  receive 
most  careful  attention.  But  before  proceeding  to  the  con- 
sideration of    individual  systems,  it  may  be  well  to  glance 


2  INTRODUCTORY  AND   RETROSPECTIVE. 

briefly  at  the  past  history  of  the  treatment  of  the  insane  in 
different  countries. 

At  the  outset,  we  are  reminded  of  the  paradoxical  saying 
of  a  distinguished  writer,  that  the  "  ultimate  tendency  of 
civilization  is  toward  barbarism."  This,  strange  as  it  may 
appear,  seems  to  have  been  exemplified  by  the  degeneracy 
in  the  methods  of  caring  for  and  treating  the  insane  in  differ- 
ent countries,  from  the  days  of  antiquity  down  to  the  be- 
ginning of  the  present  century,  and  even  later.  Among  the 
ancient  Egyptians,  the  priests,  along  with  their  supposed 
all-potent  spiritual  agencies,  employed  for  restorative  pur- 
poses such  powerful  aids  as  the  influence  of  music  and  the 
beautiful  in  nature  and  in  art,  together  with  healthy  recrea- 
tion and  agreeable  occupation.  Later,  a  member  of  a  Greek 
medical  school  publicly  condemned  the  excessive  use  of 
bodily  restraint  in  the  treatment  of  the  insane.  He  advo- 
cated the  importance  of  music  and  kindly  treatment,  as  well 
as  employment,  and  advised  that  patients  be  stimulated  to 
self-regulation  of  their  mental  powers. 

Centuries  after  those  Eastern  philosophers  had  passed 
away,  during  the  Middle  Ages,  and  down  even  to  recent 
times,  we  find  the  idea  prevalent  in  Europe  of  regarding  the 
insane  as  possessed  by  demons,  which  must  be  cast  out  to 
effect  restoration.  This  absurd  superstition  led  to  the 
adoption  of  cruel  forms  of  punishment  and  even  torture. 
The  unhappy  victims,  objects  of  general  abhorrence,  were 
commonly  cast  into  dungeons,  where  they  were  shamefully 
neglected.  It  seems  not  a  little  remarkable  that  the  won- 
derful enlightenment  of  ancient  times  respecting  this  unfor- 
tunate class,  should  have  been  followed  by  such  ignorance 
as  is  known  to  have  prevailed  during  many  succeeding  cen- 
turies. 

That  great  efficacy  in  the  cure   of  mental   diseases   was 


HOLY  WELLS.  3 

popularly  ascribed  to  spiritual  agencies,  is  abundantly  shown, 
not  only  in  legendary  lore,  but  also  in  reliable  historical 
records.  Long  pilgrimages  were  made  to  the  shrines  of  par- 
ticular saints,  who  were  believed  to  have  great  intlucncc  in 
the  work  of  mental  restoration,  and  where,  through  exorcism 
and  prayer,  miraculous  cures  were  claimed  to  have  been 
effected.  This  practice  was  not  confined  to  out-of-the-way 
places  like  Gheel,  where  St.  Dymphna  was  held  in  holy  rev- 
erence, nor  was  it  restricted  entirely  to  communities  on  the 
continent  of  Europe.  The  well  of  St.  Winifred,  St.  Nun's 
Pool,  and  other  wells  in  the  British  Isles,  were  resorted 
to  by  devout  visitors,  who  were  deeply  impressed  with  a  be- 
lief in  the  curative  influence  of  these  waters.  At  St.  Nun's 
Pool  it  was  the  custom  to  plunge  patients  backward  into  the 
water  and  drag  them  to  and  fro  until  their  excitement  was 
subdued.  Then  they  were  taken  to  the  neighboring  church, 
where,  if  there  were  signs  of  recover}-,  thanks  were  offered 
for  their  deliverance  ;  if  otherwise,  the  hydropathic  treatment 
was  continued  while  there  remained  any  hope. 

In  Ireland,  there  was  Glen-na-galt,  or  the  '^  V'alley  of  the 
Lunatics,"  beautifully  situated  in  County  Kerry,  not  far 
from  Tralee.  To  this  vale  it  was  believed  that  every  lunatic 
would  eventually  gravitate  if  left  to  himself.  The  process 
of  cure  consisted  in  drinking  the  cooling  waters  and  eat- 
ing the  cresses  that  grew  beside  the  spring. 

In  Scotland,  many  wells  were  traditionally  celebrated  for 
similar  wonderful  properties.  It  is  recorded,  that,  not  many 
years  since,  lunatics  were  denuded  and  thrice  dipped  at  mid- 
night in  Lochmanur,  in  the  far  north  of  Scotland.  More- 
over, in  the  western  highlands,  the  povcrt)--stricken  inhab- 
itants, shut  out,  as  it  were,  from  the  influence  of  town  or 
city,  are  still,  to  some  extent,  swayed  by  superstitious  no- 
tions   that    have    been    handed    down    from   father  to  son. 


4  INTRODUCTORY  AND  RETROSPECTI V L. 

Whittier  alludes  to  the  popular  belief  in  the  remarkable 
virtues  of  the  well  of  St.  Maree.  After  referring  to  the 
soothing  and  restorative  effects  from  bathing  the  fevered 
brow  therein,  he  goes  on  to  say : 

"  That  holy  well  of  Loch  Maree 
Is  more  than  idle  fable." 

Farther  south,  in  a  picturesque  district  of  the  midlands 
of  Scotland,  we  learn,  on  the  authority  of  Sir  Walter  Scott, 
that  several  wells  and  springs  were  religiously  dedicated  to 
St.  Fillan,  and  that  down  to  very  recent  times  they  were 
places  of  pilgrimage  and  offerings,  because  the  waters 
were  believed  to  be  a  potent  means  of  cure  in  cases  of 
madness. 

Far  into  the  Middle  Ages,  the  practice  of  medicine  was 
left  to  the  monks,  who  ministered  alike  to  soul  and  body. 
In  the  days  of  the  ancient  Greeks,  psychology  was  recog- 
nized as  a  department  of  medical  study  ;  but  the  ignorance 
of  the  Dark  Ages  affected  medical,  as,  indeed,  every  other 
progressive  science,  and  before  the  general  dissemination  of 
education  had  time  to  show  its  effects,  many  spurious  reme- 
dies and  crude  superstitions  were  incorporated  into  the 
healing  art.  We  may  smile  at  the  lack  of  knowledge  which 
induced  our  forefathers  to  administer,  as  remedies,  "open 
drinks,"  in  which  bitter  herbs,  ale,  and  holy  water  were  es- 
sential ingredients ;  at  the  clove-wort  wreath  enjoined  to  be 
worn  "when  the  moon  was  on  the  wane";  and  at  the  prayers 
addressed  to  the  periwinkle  at  different  stages  of  the  moon. 
The  following  was  a  more  drastic  prescription  :  "  In  case  a 
man  be  lunatic,  take  a  skin  of  mere-swine  (in  other  words 
a  sea-pig  or  porpoise),  work  it  into  a  whip  and  swinge  the 
man  therewith  ;  soon  he  will  be  well."  Some  of  the  old- 
fashioned  remedies  arc,  however,  part  of  the  pharmacopoeia 


SUPERSTITIOUS  BELIEFS.  5 

of  the  present  day,     Hyoscyamus  is   still   administered   in 
disturbed  cases. 

Throughout  the  sixteenth  century,  and  far  advanced  into 
the  seventeenth  century,  demonology  and  witchcraft  were 
generally  believed  in,  and  he  was  a  bold  man  who  ventured 
to  contradict  the  orthodox  opinions  of  the  period.  These 
superstitious  beliefs  were  not  confined  to  the  illiterate.  No 
less  a  personage  than  James  VI.  of  Scotland,  afterwards 
king  of  England,  wrote  a  learned  dissertation  on  "  Demon- 
ology," in  which  he  displayed,  perhaps,  more  zeal  than  dis- 
cretion, by  contending  that  evidence  not  admissible  against 
other  offenders  should  be  accepted  against  so-called  witches  ; 
that  marks  about  their  persons  should  be  diligently  searched 
for  and  "  pricked  with  a  long  needle,"  to  ascertain  whether 
they  were  insensible  to  pain  (such  insensibility  being  unmis- 
takable evidence  of  the  satanical  mark,  or  "  seal  of  the 
devil  ")  ;  and  that  their  bodies  should  be  floated  on  water, 
as  further  aids  in  discovering  the  guilt}-.  Toward  the  close 
of  the  sixteenth  century,  certain  medical  authorities  began 
openly  to  rebel  against  these  accepted  doctrines,  whereupon 
they  were  severely  censured  by  the  royal  James  for  what  he 
was  pleased  to  term  their  "  damnable  opinions." 

As  recent  as  17 16,  a  woman  and  her  daughter  were  sen- 
tenced to  death  at  Huntingdon,  by  an  English  bench  of 
judges,  for  ''selling  their  souls  to  the  devil."  ]\Iany  such 
poor  people,  it  is  hardly  necessary  to  say,  were  simply 
mentally  deranged,  and  had  they  been  so  fortunate  as  to 
live  in  recent  times,  they  would  have  been  humanely  cared 
for  in  some  lunatic  asylum.  Such  deplorable  ignorance 
and  superstition,  however,  were  by  no  means  limited  to 
England.  In  Scotland,  also,  the  practice  was  common  of 
putting  the  insane  to  death,  under  the  belief  that  they  were 
witches  and  possessed  of  an  evil  spirit.      Instances  of  similar 


6  INTRODUCTORY  AND   RETROSPECTIVE. 

superstitions  might  be  multiplied  from  the  records  of  our 
own  and  other  countries. 

The  first  asylum  of  which  we  find  mention  in  history 
is  one  said  to  have  been  erected  by  the  monks  at  Jerusalem 
in  the  latter  part  of  the  fifth  century.  The  learned  monks 
appear  to  have  been  the  principal  pioneers  of  this  charity 
during  the  Middle  Ages,  though  there  are  evidences  that 
provision  for  the  insane  was  not  entirely  neglected  by  the 
Mohammedans.  Among  European  countries,  in  the  fifteenth 
century,  Spain,  then  a  centre  of  learning,  seems  to  have 
taken  the  lead  in  providing  for  this  class.  The  treatment 
adopted  in  Spain,  as  elsewhere,  was,  however,  cruel  in  the 
extreme,  and  was  based  on  the  general  belief  that  the  in- 
sane were  possessed  by  evil  spirits.  Many  were  burned  to 
death,  others  were  scourged  and  tortured  in  the  vain  hope 
of  expelling  the  demons  and  liberating  the  victims  from  the 
power  of  the  Prince  of  Darkness.  It  should  be  acknowl- 
edged, that,  amidst  all  these  prevailing  errors,  the  monks 
at  Saragossa  had  the  first  faint  conception  of  rational 
open-air  treatment  for  the  mentally  deranged  to  be  found  in 
modern  times. 

So  great  a  revolution  has  taken  place  within  the  past  few 
generations  in  the  methods  of  caring  for  the  insane,  that  we 
are  scarcely  able  to  realize  that  a  hundred  years  have  not 
elapsed  since  persons  of  unsound  mind  were  treated  worse 
than  wild  beasts, — everywhere  kept  under  bolt  and  bar,  or 
heavily  manacled  in  cells  and  dungeons,  the  poisoned  atmos- 
phere of  which  not  only  prevented  cure,  but  hastened  death. 
But  a  little  earlier,  in  some  cases  they  were  exhibited  in 
cages  to  the  public,  at  fixed  rates,  and  were  irritated  and 
tormented  to  gratify  a  morbid  and  vulgar  curiosity.  As  a 
result  of  this  treatment,  many  who  originally  were  not  beyond 
hope   of   recovery,  became   permanently  deranged.     Those 


REFORMS  BY  PINEL.  7 

who  were  not  deemed  dangerous  to  the  pubHc  safety  were 
left  to  roam  about  the  country  in  a  neglected  and  pitiable 
condition.  It  is  difificult  to  conceive  that  a  century  has  not 
passed  since  the  Herculean  labors  of  Pinel  were  needed  to 
loosen  the  chains  of  the  miserable  occupants  of  the  Bicetre 
in  Paris — an  act  which,  as  is  well  known,  revealed  to  the 
world  the  striking  superiority  of  kindly  treatment  over  the 
torture,  worse  than  death,  to  which  insane  men  and  women 
were  at  that  time  subjected  in  different  parts  of  Europe. 
This  marks  so  important  an  era  in  the  history  of  the  treat- 
ment of  the  insane,  that  no  excuse  is  necessary  for  advert- 
ing to  some  of  the  attendant  circumstances  of  that  great 
achievement. 

jPin^h  who  had  attained  some  distinction  as  an  alienist, 
Avas  appointed,  in  1792,  to  fill  the  post  of  superintendent  of 
the  Bicetre,  which  then  contained  upwards  of  two  hundred 
male  patients,  believed  not  only  to  be  incurable,  but  entirely 
uncontrollable.  The  previous  experience  of  the  physician, 
here  stood  him  in  good  stead.  He  had  been  a  diligent  stu- 
dent of  the  authorities  of  his  own  and  foreign  countries 
on  diseases  of  the  mind,  and  in  his  earlier  years  had  been  ap- 
pointed by  the  French  government  to  report  on  the  condi- 
tion of  the  asylums  at  Paris  and  Charenton.  On  assuming 
the  oversight  of  the  Bicetre,  he  found  fifty-three  men 
languishing  in  chains,  some  of  whom  had  been  bound  for  a 
great  number  of  years.  These  were  regarded  by  the  author- 
ities as  dangerous  and  even  desperate  characters  ;  but  the 
sight  of  men  grown  gray  and  decrepit  as  the  result  of  pro- 
longed torture,  made  a  very  different  impression  on  the 
mind  of  Pinel.  He  addressed  appeal  after  appeal  to  the 
Commune,  craving  power  to  release,  without  delay,  the  un- 
happy beings  under  his  charge.  The  authorities  tardily  and 
unwillingly  yielded  to  the  importunity  of  the  physician.    An 


8  INTRODUCTORY  AND  RETROSPECTIVE. 

official,  who  was  deputed  by  the  Commune  to  accompany 
the  superintendent  and  watch  his  experiment,  no  sooner 
caught  sight  of  the  chained  maniacs  than  he  excitedly  ex- 
claimed :  ^^AJi,  ca  !  citoycn,  es-tii  foil  toi-mime  de  vouloir  de'cJiai- 
ner  de  pareils  animaux  ?  "  '  The  physician  was  not  to  be  de- 
terred, however,  from  carryingout  his  benevolent  project,  and 
did  not  rest  satisfied  until  all  of  the  fifty-three  men  had  been 
gradually  liberated  from  their  chains.  Singular  as  it  may  ap- 
pear, the  man  who  had  been  regarded  as  the  most  dangerous, 
and  who  had  survived  forty  years  of  this  severe  treatment, 
was  afterwards  known  as  the  faithful  and  devoted  servant  of 
Pinel.  The  reforms  of  Pinel  were  not  confined  to  the  Bi- 
cetre,  an  establishment  exclusively  for  men,  but  extended  to 
the  Salpetrierc,  an  institution  for  women.  \  There  is,  per- 
haps, no  more  touching  event  in  history  than  that  of  this 
kind-hearted  and  wise  physician  removing  the  bands  and 
chains  from  the  ill-fated  inmates  of  this  place  of  horrors. 

The  monstrous  fallacy  of  cruel  treatment  once  fully  ex- 
posed, the  insane  came  to  be  looked  upon  as  unfortunate 
human  beings,  stricken  with  a  terrible  disease,  and,  like  other 
sick  persons,  requiring  every  aid  which  science  and  benevo- 
lent sympathy  could  provide  with  a  view  to  cure.  Govern- 
mental inquiries  were  instituted  with  a  view  to  the  attain- 
ment of  better  treatment,  and  in  different  countries,  almost 
simultaneously,  the  provision  of  suitable  and  adequate  ac- 
commodation for  the  insane  was  declared  to  be  a  State 
necessity. 
)  After  scientific  thought  had  at  length  been  turned  to  the 
cure  of  insanity,  many  new  and  strange  devices  for  its  treat- 
ment were  adopted,  which  underwent,  one  after  another,  the 
test  of  experiment.  Some  of  these,  in  our  day,  are  con- 
sidered   not    only  absurd,   but    highly   injurious,   although 

'  Ah,  now  !    citizen,  art  thou  mad  thyself  to  desire  to  unchain  such  animals  ? 


THE    DOCTOR    THINKS  THAT  "NO    WELL-REGULATED    INSTITUTION    SHOULD    BE 
UNPROVIDED    WITH   THE    CIRCULATING    SWING."     1818. 


EXPERIMENTS.  g 

originating  with  men  distinguished  for  their  learning,  who 
regarded  them  at  the  time  as  most  reasonable  and  efficacious. 
An  illustration  of  one  of  these  devices  is  found  in  an  inven- 
tion of  the  medical  superintendent  of  a  foreign  insane 
asylum.  It  is  described  in  a  work  published  by  him  in  i8i8, 
in  which  he  gives  his  observations  and  experience  as  follows : 

^'  "  The  circulating  swing   erected  in   our  asylum   appears  to  be 

an  improvement  on  the  model   suggested  by  Doctor .     It 

is  worked  by  a  windlass,  and  capable  of  being  revolved  a  hun- 
dred times  in  a  minute  ;  but  can  with  ease  be  regulated  to  the 
degree  best  suited  to  the  intent.  It  is  now  adapted  for  one  per- 
son only  instead  of  four,  as  had  been  at  first  contrived  ;  the  same 
movement  being  seldom  admissible  for  more  than  one  patient. 
To  the  body  of  the  machine  is  affixed  the  apparatus  for  the  hori- 
zontal position,  which,  when  necessary,  may  at  a  moment  be  ac- 
commodated to  the  purpose. 

'*  Powerful  as  this  contrivance  has  hitherto  proved,  still,  in 
some  cases,  where  its  influence  was  much  sought  for,  it  has  had 
but  trivial  effect,  though  put  in  motion  to  its  full  extent.  The 
idiots  of  the  establishment  have  been  permitted  to  use  it  for 
amusement  without  any  inconvenience,  and  the  strictly  insane 
also,  during  their  intervals,  with  equal  satisfaction.  The  latter, 
however,  on  the  return  of  the  paroxysms,  were  found  incapable 
of  resisting  its  most  gentle  rotations  for  five  minutes  in  con- 
tinuance. 

"  In  several  cases  of  continued  insanity  of  long  standing,  where 
the  swing  had  been  employed  as  a  last  resource,  I  have  been 
most  agreeably  surprised  at  the  unexpected  alteration  which 
was  effected  after  a  few  trials.  In  some,  who,  from  their  dispo- 
sition to  violence,  and  who  from  necessity  were  closely  contmed 
to  solitary  apartments,  it  had  so  far  succeeded  as  not  only  to 
render  them  easy  of  access,  but  also  to  induce  kind  and  gentle 
manners,  effecting  in  the  end  the  most  willing  service  in  the  daily 
occupations  of  cleansing,  and  attendance  on  the  sick.  It  may  be 
proper  to  remark  that  those  persons  previously  to  any  such 
amendment  were  invariably  affected  from  the  disturbance  occa- 
sioned by  the  swing,  with  a  smart  fever  of  eight  or  ten  days  dura- 
tion, and  from  which  the  favorable  occurrence  here  alluded  to, 
seemed   to   have   arisen.     I  cannot  undertake  to  say  that,  where 


lO  INTRODUCTORY  AND  RETROSPECTIVE. 

the  disease  had  assumed  the  chronic  and  uninterrupted  form,  any- 
one instance  of  complete  recovery  has  as  yet  followed  from  its  use  ; 
yet  as  it  has  thus  far  established  its  utility,  it  is  to  be  presumed 
that  no  well-regulated  institution  intended  for  the  relief  of  the 
insane  will  be  unprovided  with  a  swing  of  a  proper  conotruction 
as  a  curative  expedient  eminently  adapted  to  the  purposes  for 
which  it  is  so  particularly  recommended."  H--'''^ 

The  same  learned  and  worthy  doctor  describes  a  belt 
and  a  leg  chain  of  his  invention,  which  he  considered  great 
remedial  agencies,  as.  by  the  use  of  these  appliances,  pa- 
tients under  treatment,  however  violent,  could  take  daily 
exercise. 

"  To  obviate  the  supposed  inexpediency  of  freeing  maniacal 
patients  from  close  confinement,  and  to  provide  against  the  pos- 
sibility of  their  using  unrestrained  violence  during  this  indul- 
gence, a  broad  strap,  made  of  strong  leather,  has  been  provided, 
which  embraces  the  body  directly  under  the  axillse.  At  the  sides 
of  this  strap  are  affixed  other  narrower  straps,  fitted  to  hold  each 
arm,  so  as  to  be  buckled  behind,  and  by  which  means  they  are 
effectually  secured.  The  main  strap  is  closed  behind  with  loop- 
holes and  rings,  through  which  a  small  iron  pin  passes,  stayed  at 
top,  and  fitted  at  bottom  for  a  padlock.  To  prevent  the  body 
strap  from  slipping  down,  a  loose  circular  band  of  leather  extends 
from  the  front  edge  over  the  head  and  lodges  broadly  on  the 
shoulders,  which  is  also  secured  behind  by  a  loop-hole  and  small 
strap  attached  to  one  of  the  rings  through  which  the  pin  is  di- 
rected. By  this  method  the  whole  is  preserved  from  being 
shifted,  and  it  most  completely  prevents  the  use  of  either  hand 
for  any  injurious  purpose.  The  object  of  exercise  is,  however, 
sufficiently  attained,  for  which  the  open  galleries  of  the  institu- 
tion are  very  well  adapted,  till  at  length  the  patients  are  permit- 
ted, under  the  same  restrictions,  to  pass  into  the  open  air. 

**A  determined  perseverance  in  this  plan,  sometimes  under  very 
remarkable  circumstances,  has  had  its  full  reward.  Gangrene  of 
the  lower  extremities  is  no  longer  known  in  the  asylum.  No  pa- 
tient is  allowed  to  remain  confined  to  bed  during  the  absence  of 
fever,  or  to  his  apartment,  unless  on  the  principle  of  occasional 
punishment." 


SHOWING    HOW    BANDS   AND    CHAINS   IN    THE    PAST    WERE    MISTAKENLY    USED    AS 
AUXILIARIES  TO    CURE. 


INSANE   AS   SICK  PERSONS.  \\ 

Perhaps  some  of  the  means  employed  in  the  early  history 
of  curative  treatment  do  not  seem  more  ridiculous  to  us  than 
some  of  the  remedies  that  we  employ,  will,  in  after  time, 
appear  to  our  successors.  It  would,  therefore,  seem  the  part 
of  wisdom  to  be  not  over-confident  in  our  present  methods 
of  treatment,  but  to  look,  with  careful  inquiry,  to  new  sources 
of  relief  that  promise  good  results. 

Pursuing  the  history  of  the  treatment  of  the  insane  and 
turning  our  attention  from  the  Old  World  to  the  New,  we 
find  that,  in  America,  many  distinguished  philanthropists 
have,  during  the  present  century,  labored  with  zeal  and  en- 
ergy to  ameliorate  the  condition  of  this  class  ;  and  in  the 
alleviation  of  suffering  humanity  they  have  performed  a 
noble  work. 

The  initial  point  in  hospital  treatment  of  the  insane,  in 
this  country,  was  in  1750,  when  there  was  projected  in  the 
"  Province  of  Pennsylvania  "  a  small  hospital,  to  be  located  at 
Philadelphia,  in  w^hich  the  principle  of  treating  the  patients 
as  "  sick  persons  "  was  recognized.  The  Act  incorporating 
it,  passed  in  1751,  was  entitled  "An  act  to  encourage  the 
establishing  of  a  hospital  for  the  relief  of  the  sick  poor  of 
this  province,  and  for  the  reception  and  care  of  lunaticks." 
This  small  institution,  begun  purely  as  a  curative  establish- 
ment, in  what  had  been  a  private  dwelling,  was,  at  its  out- 
set, dependent  on  private  subscriptions.  The  services  of 
the  visiting  physicians  were  gratuitous,  and  medicines  were 
also  furnished  free  of  charge.  At  this  time,  punishment,  in 
one  form  or  another,  was,  in  general  estimation,  regarded  as 
only  second  in  importance  to  bleeding,  purging,  and  dosing. 
Even  when,  in  1783,  the  philanthropic  Dr.  Rush  resolved  to 
relinquish  the  whips  and  chains  of  his  da}',  he  still  adhered 
to  "  mild  and  terrifying  modes  of  punishment,"  and,  on 
paying  a  visit  to  an  insane  man,  deemed  it  one  of  the  first 
requisites  "to  look  him  out  of  countenance." 


12  INTRODUCTORY  AND  RETROSPECTIVE. 

The  first  State  asylum  erected  in  this  country,  and  exclu- 
sively devoted  to  the  insane,  was  opened  at  Williamsburg, 
Virginia,  in  1773.  The  building  was  erected  at  a  cost  of 
i^  1,070,  and  supplied,  also,  the  wants  of  Kentucky,  which 
had  not  then  taken  rank  as  a  State.  The  object  of  this  in- 
stitution, as  defined  by  an  act  of  the  Legislature,  was  the 
"  cure  of  those  whose  cases  are  not  become  quite  desperate, 
and  for  restraining  others  who  may  be  dangerous  to  so- 
ciety." 

In  1817,  the  Society  of  Friends  in  America,  stimulated 
by  reports  of  the  good  work  then  being  accomplished  at  the 
York  Retreat  in  England,  purchased  fifty-two  acres  of  land 
at  Frankford,  near  Philadelphia,  and  there  opened  a  hos- 
pital, the  object  of  which  is  best  expressed  in  the  language 
of  the  projectors,  "  that  the  insane  might  see  that  they  were 
regarded  as  men  and  brethrcny 

The  organization  of  the  McLean  Asylum,  at  Somerville, 
Mass.,  in  1818,  begun  in  a  building  that  had  been  a  private 
dwelling,  was  another  important  event  in  respect  to  recog- 
nizing the  principle  of  State  supervision  ;  part  of  its  board 
of  trustees,  charged  with  weekly  visitation,  being  appointed 
directly  by  the  Governor  of  the  State.  Then  followed  a 
period  of  great  reforms,  in  which  men  of  eminence  in  the 
medical  profession,  and  philanthropists  like  Miss  Dix,  re- 
ceived hearty  legislative  cooperation  in  their  work.  In  this 
way  institutions  for  the  insane  in  the  United  States  have, 
since  1829,  been  increased  more  than  tenfold. 

In  the  State  of  New  York,  we  find  that  the  first  legisla- 
tive recognition  of  the  necessity  of  asylum  provision  for  the 
insane  was  in  1801,  when  an  act  was  passed  providing  that 
lunatics  might  be  admitted  into  a  department  of  the  New 
York  Hospital,  the  committing  authorities  paying  for  their 
maintenance.     State  aid  was  granted  in  furtherance  of  this 


FJiOGRESS   OF  REFORM. 


13 


object.  The  records  of  the  Hospital,  however,  show  that 
insane  patients  had  been  admitted  as  early  as  1797.  In 
1808,  a  separate  building,  known  as  the  South  Hospital,  was 
also  opened  for  this  class.  Aided  still  further  by  special 
grants  from  the  Legislature,  a  branch  of  the  institution  de- 
voted exclusively  to  the  insane  was  opened  in  1821,  undei 
the  name  of  the  Bloomingdale  Asylum. 

In  the  period  which  elapsed  from  1830  to  1850,  great  and 
rapid  advances  were  made  throughout  the  United  States  in 
methods  of  caring  for  the  insane.  The  reforms  then  ac- 
complished attracted  the  attention  of  Europe,  and  it  may 
be  said,  without  any  egotism,  that  they  were  in  advance  of 
contemporary  progress  in  other  countries.  But  excellence 
can  be  maintained  only  by  continual  progress.  It  has  been 
freely  asserted,  that,  from  the  middle  of  the  century  up  to  a 
comparatively  recent  period,  this  country  failed  to  keep 
pace  with  the  spirit  of  reform  elsewhere  manifested.  It  is 
gratifying  to  reflect,  however,  that  during  the  past  decade 
the  advances  made  here  have  been  as  rapid  as  in  the  period 
between  1830  and  1850.  Should  this  improvement  continui:, 
it  seems  not  unreasonable  to  expect  that  the  time  is  not  far 
distant  when  the  methods  of  caring  for  the  insane  in  the 
United  States  will  reach  a  higher  standard  than  those  of  any 
other  country. 

Among  the  criticisms  of  British  specialists  who  have  visited 
asylums  in  this  country  are  the  following  :  That  some,  even  of 
our  most  modern  institutions,  are  unnecessarily  prison-like 
in  construction  ;  that  restrictions  which  are  positivcl}'  hurt- 
ful are  still  imposed  upon  patients;  and  that,  in  other 
respects,  the  asylum  systems  of  the  United  States  are  more 
artificial  and  less  natural  or  homelike  than  the  systems 
of  some  other  countries.  It  is  not  to  be  supposed  that  these 
criticisms  apply  to  all  of  our  as}-lums,  the  statements  being 


Ctbraru  nf 


14  INTRODUCTORY  AND  RETROSPECTIVE. 

entirely  and  admittedly  inapplicable  to  some  of  our  best- 
managed  institutions.  But,  whatever  maybe  the  measure  of 
application  of  these  strictures,  they  have  been  advanced  by 
men,  who,  in  their  own  country,  are  regarded  as  authorities, 
and  should  receive  careful  and  candid  consideration. 

The  writer  does  not  expect  that  the  succeeding  pages  will 
set  at  rest  controverted  points  that  have  been  raised  respect- 
ing the  care  and  treatment  of  the  insane  ;  but  he  hopes  that 
some  of  the  illustrations  given  of  foreign  methods  will  prove 
helpful  to  those  concerned  in  the  adjustment  of  questions 
now  uppermost  in  the  public  mind  and  bearing  on  a  subject 
of  more  than  national  importance,  affecting,  as  it  does,  the 
whole  human  family. 


CHAPTER  II. 
ENGLAND. 

THE  history  of  the  treatment  of  the  insane  in  England  is 
the  history  of  a  protracted  struggle  between  the  forces 
of  a  humane  and  enlightened  civilization  on  the  one  hand,  and 
of  a  formidable  and  unyielding  conservatism  on  the  other. 
Before  adverting  to  the  high  position  which  many  of  the 
English  asylums  have  attained,  it  may  be  well  to  recall 
briefly  the  gradual  steps  by  which  this  was  reached.  In 
1547,  a  monastic  institution,  established  some  three  hun- 
dred years  earlier,  and  now  known  as  Bethlem  Hospital, 
was  converted  by  Henry  the  Eighth  into  an  asylum,  or 
more  correctly  speaking,  a  "  dungeon-house,"  for  furious 
lunatics,  in  which  capacity  it  became  popularly  known  as 
Bedlam.  This  is  the  first  public  institution  in  England 
devoted  to  the  insane  of  which  we  have  any  record.  It 
was  only  large  enough  to  accommodate  some  sixty  pa- 
tients, and  in  1675  it  was  removed  to  Moorfields,  where  a 
building  for  one  hundred  and  fifty-two  inmates  was  erected. 
Extensive  additions  were  made  to  the  hospital  from  time  to 
time,  but  in  18 1 2  it  became  necessary  to  again  change  the 
site,  and  the  more  modern  structure  was  built  in  St. 
George's  Field. 

The  earliest  recorded  English  legislation  bearing  direct!)' 
upon  the  insane  poor  was  in  1744,  in  George  the  Second'.s 
time,  when  any  two  justices  were  empowered  to  order  the 

15 


1 6  ENGLAND. 

arrest  of  pauper  lunatics  found  at  large,  and  have  them 
chained  and  locked  up  in  "  some  secure  place  "  within  their 
parish  of  settlement.  Up  to  this  period,  such  provision  as 
had  been  made  for  the  insane  was,  however,  mainly  that  of 
custodial  care  for  those  who  were  dangerous  to  be  at  large. 
Many  of  the  mentally  deranged  were  to  be  found  wander- 
ing about  the  country  in  a  condition  of  pitiable  neglect — a 
source  of  apprehension  and  annoyance  to  the  public,  and  an 
unwelcome  addition  to  the  mendicancy  of  the  time,  which  is 
thus  graphically  sketched  by  Shakespeare  : 

"  The  countiy  gives  me  proof  and  precedent 
Of  Bedlam  beggars,  who,  with  roaring  voices, 
Strike  in  their  numb'd  and  mortified  bare  arms 
Pins,  wooden  pricks,  nails,  sprigs  of  rosemary  ; 
And  with  this  horrible  object,  from  low  farms. 
Poor  pelting  villages,  sheep-cotes,  and  mills, 
Sometime  with  lunatic  bans,  sometime  with  prayers, 
Enforce  their  charity." 

The  first  asylum  in  England  in  which  the  curative  princi- 
ple is  distinctly  discernible,  is  that  of  St.  Luke's,  erected  by 
the  subscriptions  of  a  few  charitable  persons  in  London,  in 
1 75 1.  About  the  close  of  the  eighteenth  century,  there 
were  in  England  not  more  than  five  public  asylums — mostly 
endowed — and  only  a  few  private  institutions. 

Down  to  the  year  1770,  Bethlem  Hospital,  which  was 
then,  as  now,  managed  by  a  board  of  governors,  derived  a 
considerable  revenue  in  fees  from  the  public  exhibition  of 
the  insane,  heavily  manacled  and  chained,  or  kept  in  cages 
of  iron.  It  would  appear  that  the  visitations  on  the  part  of 
the  curious  were  the  only  kind  of  inspection  to  which  these 
institutions  were  subject  ;  and,  until  the  year  1853,  the  gov- 
ernors of  Bethlem  Hospital  resented,  and  successfully  resisted, 
governmental  supervision.  Influenced  probably  by  a  national 
calamity,  in  that  the  reigning  sovereign,  George  III.,  had 


ESTATES   OF  LUNATICS, 


17 


several  times  been  attacked  by  insanity,  public  attention  was 
in  his  day  fairly  aroused  to  the  necessity  for  humane  and 
more  perfect  asylum  accommodation  and  supervision.  In 
1774,  an  act  was  passed  directing  the  Royal  College  of  Phy- 
sicians in  London  to  appoint  a  commission,  consisting  of 
five  of  its  Fellows,  to  visit  and  license  the  "  mad-houses,"  as 
they  were  then  termed,  situated  within  the  cities  of  London 
and  Westminster,  or  within  seven  miles  thereof.  The  Act 
further  directed  that  similar  duties  should  be  performed  by 
the  magistrates  in  their  respective  districts. 

The  custody  of  the  estates  of  idiots,  formerly  intrusted  to 
the  feudal  superior,  was,  in  the  reign  of  Edward  II.,  vested 
in  the  King,  and  proved  no  inconsiderable  source  of  revenue 
to  the  crown.  A  distinction  was  made  by  law  as  between 
idiots,  or  "  natural  fools,"  and  lunatics.  Blackstone  defines 
an  idiot  as  "  one  who  hath  had  no  understanding  from  his 
nativity,  and  therefore  is  by  law  presumed  never  likely  to 
attain  any  "  ;  and  a  lunatic  as  "  one  who  hath  had  under 
standing,  but  by  disease,  grief,  or  other  accident  hath  lost 
the  use  of  his  reason."  In  the  case  of  the  former  there  was 
forfeiture  of  the  surplus  profits  of  the  estate  during  the  life- 
time of  the  idiot,  after  supplying  him  with  necessaries  ;  in 
the  case  of  a  lunatic,  the  crown  acted  as  trustee,  protecting 
his  person  and  property,  and  accounting  to  him,  if  he  re- 
covered, for  all  profits  received,  or  to  his  representatives  in 
the  event  of  his  death.  In  the  case  of  idiots  the  propcrt}- 
was  preserved  for  the  benefit  of  the  heirs.  Thus  appears  to 
have  originated  that  care  or  guardianship  of  estates  of  idiots 
and  lunatics  which  is  still  maintained  by  the  Court  of  Chan- 
cery. 

But  whatever  of  humane  care  was  manifested,  it  was 
apparently  confined,  as  Chancery  care  is  now  confined,  to 
those  possessed  of  estates.     Pauper  and  criminal   lunatics, 


1 8  ENGLAND. 

violent,  and  dangerous  to  be  at  large,  were,  without  cere- 
mony, relegated  to  the  gloomiest  confines  of  jails  and  work- 
houses.' Even  in  what  were  termed  asylums,  the  accommo- 
dation included  dark,  damp  cells,  where,  as  if  to  accelerate 
death,  iron  cages,  manacles,  wristlets,  and  massive  chains 
were  unrelentingly  employed,  lacerating  and  discoloring  the 
flesh  of  the  unhappy  victims.  A  grave  abuse  connected 
with  these  receptacles  for  the  insane,  lay  in  the  fact  that 
they  were  resorted  to  by  the  powerful  and  unscrupulous  as 
conveniences  for  getting  rid  of  any  relative  who  might  hap- 
pen to  stand  in  the  way  of  their  selfish  aims.  The  poorer 
classes  were  crowded  to  suffocation  in  dungeons,  bled  pro- 
fusely, lashed  into  a  state  of  complete  exhaustion,  or,  as  too 
frequently  happened,  were  brutally  kicked  to  death  by  some 
unfeeling  attendant,  who,  free  from  supervision,  knew  that 
he  might  with  impunity  inflict  fatal  injury  upon  any  one  of 
the  patients  committed  to  his  charge.  This  fearful  state  of 
things  is  amply  substantiated  by  competent  authorities. 
The  late  Dr.  R.  Gardiner  Hill  says: 

"  In  the  early  part  of  the  present  century,  lunatics  were  kept 
constantly  chained  to  walls  in  dark  cells,  and  had  nothing  to  lie 
upon  but  straw.  Some  were  chained  in  dungeons,  and  were 
gagged,  outraged,  and  otherwise  abused.  The  keepers  visited 
them  whip  in  hand,  and  lashed  them  into  obedience  ;  they  were 
also  half-drowned  in  baths  of  surprise,  and  in  some  cases  semi- 
strangulation  was  resorted  to.  The  bath  of  surprise  was  so  con- 
structed that  patients,  in  passing  over  a  trap-door,  fell  in.  Some 
were  chained  in  wells,  and  the  water  made  to  rise  until  it  reached 
the  patient's  chin.  .  .  .  Patients  in  a  state  of  nudity,  women  as 
well  as  men,  were  flogged  at  particular  periods,  chained,  strapped 
and  fastened  to  iron  bars,  and  even  confined  in  iron  cages." 

The  cruel  treatment  of  the  times  is  truthfully  illustrated 
by  the  oft-quoted  case  of  Norris,  who  was  an  inmate  of  Beth- 
lem  Hospital  before  that  place  came  to  rank,  as  it  now  does, 

'  Workhouse  in  l-^ngland  is  synonymous  \s\\h. poorhouse. 


NORRIS  IN  CHAINS 


INHUMAN    TREATMENT.  I9 

among  the  better  class  of  English  asylums.  It  appears  that 
Norris,  in  an  outburst  of  passion  to  which  the  nature  of  his 
infirmity  rendered  him  momentarily  liable,  had  struck  the 
apothecary  of  the  asylum,  and  for  this  offence  was-  kept  in 
irons  for  twelve  years !  The  refinement  of  torture  was  in 
this  instance  reached  by  keeping  the  victim  in  such  a  po- 
sition that  he  could  not  stand  upright  !  A  reliable  authority 
thus  particularly  describes  the  mode  of  his  restraint: 

"A  stout  iron  ring  was  riveted  round  his  neck,  from  which  a 
short  chain  passed  to  a  ring  made  to  slide  upwards  or  downwards 
on  an  upright  massive'  iron  bar  inserted  into  the  wall.  Round 
his  body  a  strong  iror^  bar  about  two  inches  wide  was  riveted  ;  on 
each  side  of  the  bar  was  a  circular  projection,  which,  being  fas- 
tened to  and  inclosing  each  of  the  arms,  pinioned  them  close  to  his 
sides.  The  waist-bar  was  secured  by  two  similar  bars,  which, 
passing  over  his  shoulders,  were  riveted  to  the  waist-bar  both  be- 
fore and  behind.  The  iron  ring  round  his  neck  was  connected 
to  his  shoulders  by  a  double  link.  From  each  of  these  bars 
another  chain  passed  to  the  ring  on  the  upright  iron  bar.  His 
right  leg  was  also  chained." 

That  cruelty  of  the  kind  above  described  should  have  been 
possible  as  recent  as  the  year  181 5 — twenty-three  years  after 
Pinel's  great  reform  in  France,  and  after  Tuke's  introduc- 
tion of  humane  principles  at  the  York  Retreat — is  almost 
beyond  belief.  Yet  authentic  records  show  that  Bethlem 
Hospital  was  by  no  means  the  only  one  where  the  patients 
were  brutally  treated.  It  was  the  discovery  of  similar  scan- 
dalous practices  at  the  York  Asylum — established  by  general 
subscription  in  1777 — that  led  William  Tuke,  in  behalf  of 
the  Society  of  Friends,  to  found  the  famous  Retreat  at 
York,  long  the  only  English  institution  of  its  kind  in  which 
chains,  leg-locks,  and  hand-cuffs  were  totally  discarded.  The 
circumstances  leading  to  the  establishment  of  this  novelty 
in    asylum   management  were   as   follows :    The   Society  of 


20  ENGLAND. 

Friends  in  1791  sent  one  of  their  number,  a  female  patient, 
to  the  York  Asylum,  when  it  was  learned,  that,  by  the 
rules  of  the  institution,  none  of  her  relatives  would  be  per- 
mitted to  see  her.  There  was  reason  to  fear  that  the  reports 
then  in  circulation  about  the  inner  workings  of  this  place  of 
concealment  and  confinement  were  not  without  foundation, 
and  as  the  result  of  investigations,  the  Society  resolved  to 
erect  an  independent  hospital  where  moral  treatment  should 
have  precedence  over  mechanical  methods. 

The  Retreat  was  opened  accordingly  in  the  year  1796. 
One  of  the  first  patients  admitted  was  a  man  who  had  been 
chained  for  twenty  years.  Under  the  new  regime  of  kind 
and  more  intelligent  treatment,  he  was  at  first  restricted  only 
by  the  occasional  use  of  arm-straps,  and  he  soon  consented 
to  wear  his  clothes,  becoming  in  this  and  other  respects 
decent  and  orderly  in  his  habits.  The  success  attending 
these  efforts  need  not  be  dwelt  upon  here. 

Meanwhile,  the  unenviable  notoriety  of  the  York  Asylum 
increased  rather  than  diminished.  Regular  of^cial  inspec- 
tion there  was  none  to  confirm  or  refute  the  charges  which 
were  in  circulation  regarding  the  prevailing  usages.  There 
is  hardly  an  atrocity  that  could  be  named,  including  sexual 
outrage,  that  is  not  alleged  to  have  been  perpetrated  upon 
the  helpless  victims  then  incarcerated  in  the  gloomy  cells  of 
that  prison-like  structure.  Its  stone  floors  were  begrimed 
with  filth,  and  its  round  air-holes,  only  eight  inches  in  diam- 
eter, exhibited  the  merest  mockery  of  ventilation.  In  con- 
sequence of  complaints  made  by  members  of  the  Society 
of  Friends,  an  official  inquir}' was  instituted  into  the  manage- 
ment of  this  and  similar  mis-named  "public"  as\'luins.  It 
is  authoritatively  asserted  of  the  York  institution  that 
scarcely  had  the  inquiry  terminated,  when  the  wing  of  the 
asylum  which  contained  the  worst  cases  was  purposely  set 


LUNACY  LEGISLATION.  21 

-on  fire  to  destroy  evidences  of  hideous  cruelty,  and  several  of 
the  patients  were  burned  to  death.  Statistics  of  the  institu- 
tion were  found  to  have  been  falsified;  221  patients  were 
advertised  as  dead,  whereas  the  number  ought  to  have  been 
365.  Among  other  recorded  instances  of  neglect,  it  is 
stated  that  the  janitors  took  no  measures  to  protect  the  in- 
sane under  their  charge  from  the  attacks  of  rats,  which 
allowed  the  patients  neither  rest  by  day  nor  sleep  by  night. 
In  1807,  a  select  committee  of  the  House  of  Commons  in- 
quired into  the  condition  of  the  lunatic  poor,  and  in  the  fol- 
lowing year  an  act  was  passed  providing  for  the  erection  of 
properly  equipped  public  lunatic  asylums,  to  be  built  at  the 
expense  of  the  counties  or  boroughs  throughout  England 
and  Wales.  This  and  a  few  subsequent  amending  acts  left 
it  optional  with  the  justices  or  magistrates  to  provide  such 
asylums;  but,  in  1828,  only  twelve  counties  had  made  the 
requisite  provision.  By  the  year  1841,  only  six  other  coun- 
ties had  complied  by  furnishing  the  desired  accommodation. 
Meantime,  parliamentary  investigations,  of  which  there  were 
several  between  1808  and  1844,  revealed  a  very  unsatisfac- 
tory state  of  things.  Many  of  the  asylums  had  no  medical 
attendant ;  many,  both  in  and  out  of  London,  were  seldom 
visited,  and  great  abuses  were  common.  In  1828,  an  act 
was  passed  empowering  the  Home  Secretary  to  appoint, 
every  year,  fifteen  commissioners — five  being  physicians — 
for  the  purpose  of  licensing  and  visiting  the  metropolitan 
district.  Four  years  later  the  Lord  Chancellor  was  author- 
ized to  appoint  annually  the  Metropolitan  Commissioners 
in  Lunacy,  and  finally,  in  1842,  these  commissioners  were 
empowered  to  inspect  all  the  public  and  private  asylums 
throughout  England  and  Wales.  They  made  a  searching 
inquiry  into  the  condition  of  these  institutions,  and  their 
report  made  to  Parliament  in  1844  proved  of  great  value 
in  shaping  subsequent  legislation. 


22  ENGLAND. 

The  published  accounts  which  had  been  periodically  ema- 
nating from  the  York  Retreat,  were  influential  in  confirming 
the  doctrine  laid  down  by  Pinel,  the  great  French  reformer, 
that  severe  forms  of  restraint  are  hindrances,  and  not  helps,  in 
the  treatment  of  the  insane.  Yet  so  strong  was  the  preju- 
dice against  reform,  that,  when  Dr.  Hill  attempted  it  in 
the  Lincoln  Asylum  in  1838,  he  was  forced  to  resign  his 
office  of  superintendent.  In  the  following  year  Dr.  Conolly 
was  appointed  to  the  large  metropolitan  asylum  of  Hanwell, 
in  Middlesex.  Having  obtained  the  reluctant  consent  of 
the  authorities  to  what  was  believed  to  be  a  dangerous  ex- 
periment, he  boldly  adopted  those  principles  of  non-restraint 
which  had  been  already  firmly  established  by  Pinel  and  Tuke. 
So  marked  was  his  success  in  this  large  public  asylum  set 
apart  for  disturbed  cases,  that  Gloucester  and  many  other 
provincial  public  institutions,  including  even  conservative 
Lincoln,  became  converts  to  the  new  method.  The  substi- 
tution of  humanity  for  brutality  gradually  extended,  though 
much  work  had  yet  to  be  done.  It  was  commonly  considered 
as  late  as  1842,  that  old  jails  required  but  little  alteration  to 
make  them  fit  receptacles  for  the  insane. 

The  nature  of  the  provision  made  for  the  insane  about 
this  time  and  prior  to  1844,  was  described  by  the  Earl 
of  Shaftesbury,  Chairman  of  the  English  Board  of  Commis- 
sioners in  Lunacy,  before  a  parliamentary  inquiry,  in  1877, 
in  these  words  : 

"  I  recollect  I  used  to  see  as  many  as  thirty,  forty,  or  fifty  pa- 
tients chained  to  the  wall.  I  never  knew  an  attendant  go  about 
who  had  not  leg-locks  and  hand-locks  to  his  waist,  which  were 
applied  without  remorse.  I  do  not  mean  to  say  that  people  in  those 
days  were  less  humane  than  we  are  now,  but  they  were  ignorant, 
and  many  of  them  thought  that  a  madman  was  a  creature  so  de- 
void of  sense  and  feeling,  that  he  might  be  treated  not  only  as  a 
beast,   but  worse  than   a  beast.     I   remember,  as  to  the   White 


METHODS  OF  RESTRAINT.  23 

House  Asylum  in  Bethnal  Green,  it  came  out  in  the  evidence,  and 
the  physician  who  was  at  the  head  of  it  never  denied  the  state- 
ment, and  as  a  matter  of  course  he  did  not  think  there  was  any 
thing  inhuman  in  the  fact,  that,  on  Saturday  night,  from  200  to 
220  patients  were  chained  down  in  their  cribs  and  never  visited 
again  until  Monday  morning.  There  was  a  crust  of  bread  and  a 
cruse  of  water  put  beside  them,  and  they  were  left  in  their  filth. 
Pauper  patients  did  not  then  sleep  in  beds  as  they  do  now.  Go 
and  see  them  now  in  their  dormitories,  you  would  have  no  objec- 
tion to  sleep  there  yourselves  ;  but  they  were  then  put  in  cribs 
with  straw — put  in  naked, — and  there  were  holes  in  the  bottom  to 
let  the  urine  pass  ;  the  rooms  were  all  constructed  with  flags  or 
bricks,  sloping  down  in  the  centre  like  a  filthy  stable  with  a  drain 
in  the  middle,  and  there  they  were  lying  for  hours." 

Among  the  crying  defects  of  the  time  were  the  improper 
crowding  together  of  patients,  a  want  of  medical  care  and 
proper  nursing,  unnecessary  coercion  and  restraint,  and  an 
absolute  dearth  of  occupation,  recreation,  or  amusement. 
The  methods  of  restraint  in  common  use  at  this  time 
included  iron  hand-cuffs  connected  with  chains  to  a  leather 
waist-belt ;  leathern  hobbles  locked  around  the  ankles,  which 
permitted  the  patient  to  shuffle  his  feet,  but  impeded  his 
movements  so  that  he  could  not  walk;  iron  hand-cuffs  with 
chains  which  passed  through  fastening  locks  at  the  sides 
of  heavy  "  tub-bedsteads  "  filled  with  straw ;  boots  made 
of  ticking,  with  rings  and  chains  which  passed  through 
fastening  locks  at  the  bottom  of  the  bedstead. 

By  1845  it  had  become  evident  that  the  law  allowing 
magistrates,  at  their  option,  to  make  asylum  provision  was 
not  beneficial  in  its  practical  operation.  Accordingly,  by  an 
act  passed  in  that  year  it  was  made  incumbent  upon  the 
justices  of  every  county  and  borough,  within  three  years,  to 
obtain  or  provide  the  necessary  accommodation  for  their 
insane.  They  were  allowed  to  make  this  provision  cither 
separately  or  jointly  with  other  counties  or  boroughs.    This 


24  ENGLAND. 

act,  modified  by  subsequent  enactments  to  be  hereafter  re- 
ferred to,  forms  the  basis  of  the  existing  system.  The  new 
law  superseded  all  previous  legislation  on  the  subject  ;  ap- 
pointed for  life  eleven  Lunacy  Commissioners,  three  of 
whom  should  be  physicians  and  three  barristers  ;  and  direct- 
ed that  all  future  vacancies  should  be  filled  by  the  Lord 
Chancellor.  The  six  professional  commissioners  were  to  be 
the  only  paid  members,  and  they  were  specially  charged  with 
the  work  of  visiting.  A  Secretary  to  the  Commission  was 
also  appointed,  and  all  took  the  oath  of  fidelity  and  secrecy 
as  administered  by  the  Lord  Chancellor. 

The  commissioners,  acting  under  a  common  seal,  were 
empowered  to  elect  from  their  number  a  permanent  unpaid 
chairman  ;  to  make  rules  for  their  guidance  in  carrying  on 
their  work  ;  to  visit  and  supervise  all  asylums  certified  to 
receive  the  insane  throughout  England  and  Wales.  They 
were  authorized  to  inspect  the  books  and  documents 
of  the  institutions  visited  to  see  that  they  were  regularly 
kept  ;  in  short,  to  inquire  into  all  matters  and  things  per- 
taining to  the  physical  or  mental  condition  of  the  insane. 
Any  keeper  or  superintendent  withholding  the  required 
information  was  made  liable  to  pains  and  penalties  for  mis- 
demeanor. They  were  required  to  make  an  annual  report 
to  the  Lord  Chancellor,  for  presentation  to  Parliament. 

In  1852,  notwithstanding  much  previous  legislation  on  the 
subject,  several  counties  were  still  without  asylums,  and  only 
four  boroughs  had  provided  separate  accommodation.  It 
was  therefore  found  necessary  to  pass  a  still  more  stringent 
act  in  1853,  making  it  compulsory  on  justices  of  every 
county  or  borough  to  provide  for  the  wants  of  pauper  luna- 
tics in  their  districts,  either  separately  or  by  agreement  with 
others.  The  word  "  lunatic  "  was  expressly  defined  to 
"  mean   and   include  every  person   of   unsound   mind,   and 


THE  INSANE  POOR.  25 

every  person  being  an  idiot."  The  justices  were  now  re- 
quired to  appoint  committees  of  their  number  to  erect 
asylum  buildings  or  provide  needful  accommodation  ;  and  it 
was  declared  that  counties  and  boroughs  neglecting  to  so 
provide  or  contract  for  their  pauper  lunatics  should  be  an- 
nexed (for  the  purposes  of  the  Act)  by  the  Home  Secretary 
to  the  adjacent  counties.  To  meet  the  case  of  crowded 
localities  like  the  metropolis,  where  lands  and  accommoda- 
tion might  be  difificult  to  procure  within  a  given  area, 
power  was  granted  to  authorities  to  erect  and  manage  asy- 
lums outside  their  own  county  should  circumstances  so 
require.  The  cost  of  the  new  arrangement  was  directed  to 
be  defrayed  by  a  county  tax.  Borrowing  powers  were  also 
conferred  upon  local  authorities  to  meet  necessary  ex- 
penditures. 

The  primary  intent  of  the  statute  in  creating  county  and 
borough  asylums  was  to  provide  for  pauper  lunatics.  Other 
lunatics,  or  the  pauper  lunatics  of  other  counties  or  boroughs, 
may  not  be  admitted  to  any  asylum  of  this  kind  until  all  the 
pauper  lunatics  of  the  county  in  which  it  is  situated,  or  the 
counties  or  boroughs  contributing  to  it,  if  any,  are  accom- 
modated. 

The  management  of  the  county  and  borough  asylums  is 
entrusted  to  a  "  Committee  of  Visitors  "  appointed  annually 
by  the  justices  of  the  counties  and  boroughs.  This  commit- 
tee, of  whom  three  constitute  a  quorum,  are  empowered  to 
appoint  a  paid  clerk  who  may  also  be  the  clerk  of  the  asy- 
lum, and  in  whose  name  they  may  sue  and  be  sued.  The 
committee  are  likewise  empowered  to  appoint  a  resident 
superintendent,  chaplain,  treasurer,  and  such  other  officers 
and  servants  as  they  may  think  fit.  They  have  also 
power  to  discharge  the  same.  Should  a  nurse  or  attendant 
be  discharged,  the   cause  for  so  doing  must   be  reported  to 


26  ENGLAND. 

the  Commissioners  in  Lunacy.  Subject  to  the  approval  of 
the  Home  Secretary,  the  committee  may  frame  rules  and 
regulations  for  the  government  and  management  of  the  asy- 
lum under  their  charge,  and  not  less  frequently  than  once 
during  every  two  months  as  many  as  two  members  of  the 
committee  are  required  to  visit  the  asylum  together  and 
make  a  thorough  examination  of  every  part,  and  to  see,  "  if 
circumstances  will  permit,"  every  patient  therein.  They  are  to 
examine  all  commitment  papers  received  since  their  last  visi- 
tation, also  the  books  of  the  asylum,  and  they  are  required 
to  enter  in  a  book  kept  for  the  purpose  at  the  asylum  their 
impressions  of  the  condition  of  the  asylum,  the  patients, 
etc.  The  Committee  of  Visitors  report  annually  to  the 
justices  of  the  county  or  borough,  and  a  copy  of  this  report 
must  be  sent  by  them  to  the  Commissioners  in  Lunacy. 
The  statute  respecting  the  maltreatment  of  asylum  pa- 
tients provides  that — 

"  If  any  superintendent,  ofificer,  nurse,  attendant,  servant,  or 
other  person  employed  in  any  asylum  strike,  wound,  ill  treat,  or 
willfully  neglect  any  lunatic  confined  therein,  he  shall  be  guilty  of 
misdemeanor,  and  shall  be  subject  to  indictment  for  every  such 
offense,  or  to  forfeit  for  every  such  offense,  on  a  summary  convic- 
tion thereof  before  two  justices,  any  sum  not  exceeding  twenty 
pounds  nor  less  than  two  pounds." 

It  is  required  by  the  statute  that  every  house  in  which 
more  than  one  patient  is  kept,  whether  private  or  pauper, 
must  be  licensed.  The  district  lying  within  the  distance 
of  seven  miles  from  any  part  of  the  cities  of  London  and 
Westminster,  or  the  borough  of  Southwark  is  designated 
as  the  "  immediate  jurisdiction  "  of  the  Commissioners  in 
Lunacy,  and  within  this  district  licenses  are  granted  by 
them.  Elsewhere  such  licenses  are  issued  by  the  justices  of 
the  county  or  borough  within  which  the  house  is  situated. 


STATUTORY  REGULATIONS.  2/ 

The  justices  are  also  required  to  appoint  three  or  more 
justices  and  one  physician  or  more  to  act  as  local  visitors  to 
the  licensed  houses  within  their  several  localities.  The 
names  of  these  visitors  must  be  forwarded  to  the  Lunacy- 
Commissioners.  All  houses  licensed  for  one  hundred  patients 
or  more  must  have  a  resident  medical  ofificer.  If,  in  any 
house  licensed  for  less  than  one  hundred  patients,  there  be 
no  resident  medical  officer,  such  house  must  be  regularly 
visited  by  a  physician,  the  frequency  of  his  visits  being  reg- 
ulated according  to  the  number  of  patients  for  which  the 
house  is  licensed. 

It  is  also  required  that  any  hospital  or  part  of  a  hospital 
or  other  house  or  institution  (not  being  an  asylum)  wherein 
lunatics  are  received  and  supported  wholly  or  in  part  by 
voluntary  contributions,  or  by  any  charitable  bequest  or  gift, 
or  by  applying  the  excess  of  payments  of  some  patients  for 
or  towards  the  support  or  benefit  of  other  patients,  must  be 
registered  before  patients  may  be  received  therein.  Should 
the  superintendent  of  such  an  institution  fail  to  make  ap- 
plication for  registry  to  the  commissioners,  he  is  liable  to  a 
fine  of  ^20.  After  registry,  such  institutions,  which  are 
usually  governed  by  a  committee  elected  from  the  contribu- 
tors, are  designated  "  Registered  Hospitals."  Every  hospi- 
tal receiving  patients  must  have  a  resident  medical  officer. 

Under  the  law,  private  patients  are  consigned  to  asylum 
care  on  the  order  of  a  relative,  friend,  or  some  person 
authorized  to  place  the  patient  under  legal  restraint,  if 
the  document  be  supported  by  the  certificates  of  two  quali- 
fied and  registered  physicians.  In  the  case  of  Chancery 
patients,  an  order  signed  by  the  regularly  appointed  com- 
mittee is  sufficient  authority  for  the  reception  of  such  per- 
sons into  "  any  asylum,  hospital,  licensed  house,  or  otheJ 
house,"  without  a  medical  certificate.     Paupers  are  generally 


28  ENGLAND. 

sent  to  an  asylum  by  the  order  of  a  justice  together  with  a 
statement  of  particulars  and  a  medical  certificate.  In  the 
event  of  a  pauper  patient  not  being  able  to  be  taken 
before  a  justice,  the  clergyman  of  the  parish  (in  priest's 
orders)  in  conjunction  with  the  relieving  officer  or  over- 
seers, as  the  case  may  be,  can  sign  the  order  for  his 
admission  into  an  asylum.  But  in  regard  to  commit- 
ment, it  is  advisable  to  quote  from  an  official  authority. 
Secretary  Perceval,  of  the  English  Lunacy  Commission, 
has  described  before  a  parliamentary  committee  the  present 
system  of  commitment  substantially  as  follows: 

To  authorize  the  confinement  of  an  insane  person  who  has  not 
been  found  lunatic  by  inquisition,  in  any  licensed  house  or  hos- 
pital, it  is  required  that  there  should  be  a  document  called  an 
order,  addressed  to  the  proprietor  or  superintendent  by  some 
person  connected  in  some  way  with  the  lunatic,  and  supported 
by  the  certificates  of  two  registered  medical  practitioners,  '  who 
must  examine  the  patients  separately  from  each  other,  and  must 
each  sign  a  certificate  in  the  form  prescribed  by  act  of  Parlia- 
ment. Each  certificate  must  state  the  facts  upon  which  the  person 
certifying  grounds  his  opinion,  that  the  person  to  be  taken  in 
charge  is  a  lunatic  within  the  meaning  of  the  Act,  and  that  he  is  a 
proper  person  to  be  placed  under  care  and  treatment.  Those 
facts  since  1853,  are  obliged  to  be  divided  into  two  categories  : 
first,  the  facts  personally  observed  by  the  medical  men  at  the 
time  of  the  examination  ;  and,  secondly,  the  facts  communicated 
to  them,  if  any,  by  others,  specifying  the  informant.  The  medi- 
cal men  certifying  must  have  seen  the  patient  within  seven  days 
prior  to  his  admission.  The  certificates  are  good  for  seven  days 
only.  The  order  must  have  been  made  within  a  month  prior  to 
admission,  and  since  1862  the  order  cannot  be  made  by  any  per- 
son who  has  not  seen  the  patient  within  a  month.  The  person 
who  signs  the  order  does  it  entirely  upon  his  own  responsibility  ; 
he  must  state  some  circumstances  in  connection  with  the  patient, 

'  Under  special  circumstances  a  private  patient  may  he  confined  upon  the 
certificate  of  one  qualified  practitioner  ;  hut  unless  two  similar  certificates  he 
furnished  within  three  days  of  admission,  the  patient  must  then  be  discharged. 


ADMISSION.  29 

and  he  must  append  a  statement  of  particulars  giving  name,  sex, 
age,  and  previous  abode  of  the  person,  which  he  must  also  sign  ; 
and  the  statement  must  contain  the  name  and  address  of  some 
relation,  if  possible,  to  whom  notice  may  be  sent  in  the  event  of 
death.  No  person  can  sign  a  certificate  or  order  for  the  recep- 
tion of  any  private  or  other  patient  into  a  licensed  house,  if  he 
receives  any  percentage  on  the  payment  to  be  made  for  his  ad- 
mission ;  and  no  medical  man  can  sign  the  certificate  for  the  re- 
ception of  such  a  patient  into  a  house  of  which  he  or  his  father, 
brother,  son,  partner,  or  assistant  are  the  proprietors  ;  nor  can  his 
father,  son,  brother,  partner,  or  assistant  sign  the  same  reception 
order.  There  is  no  regulation  with  regard  to  the  position  in 
which  the  person  who  signs  the  order  stands  towards  the  alleged 
lunatic.  All  the  Act  says  is,  that  the  order  must  be  signed  in  the 
form  given  in  the  schedule  to  the  Act.  It  may  be  signed  by  a 
total  stranger  if  he  chooses  to  take  the  responsibility  ';  all  he  has 
to  do  is  to  state  :  "  I,  the  undersigned,  hereby  request  you  to  re- 
ceive A.  B.,  a  lunatic  (or  an  idiot,  or  a  person  of  unsound  mind,) 
as  a  patient  into  your  house  ;  subjoined  is  a  statement  respect- 
ing the  said  A.  B."  And  then  there  is  the  name  of  the  person 
signing,  and  there  is  his  occupation  and  place  of  abode,  and  his 
degree  of  relationship  (if  any)  or  other  circumstance  of  con- 
nection with  the  patient.  The  order  is  not  countersigned  by 
any  authority.  There  is  no  provision,  as  there  ought,  in  my  opin- 
ion, to  be,  making  it  the  duty  of  some  one  to  inquire  of  the  per- 
son signing  the  order  Avhat  reasons  he  has  for  signing,  or 
if  there  are  any  persons  more  nearly  related  to  the  alleged 
lunatic  than  himself.  The  sole  safeguard  is  the  responsi- 
bility incurred  by  the  person  signing  the  order,  which  re- 
sponsibility amounts  to  the  risk  of  a  civil  action  on  the  part 
of  any  person  who  considers  himself  aggrieved.  The  person 
taking  charge  of  the  alleged  lunatic  is  required  within  twenty- 
four  hours  to  send  notice  of  admission  of  the  patient  to 
the  Commissioners  in  Lunacy,  and  if  he  be  the  proprietor 
or  superintendent  of  a  licensed  house  in  the  provinces,  he 
must  also  send  notice  to  the  clerk  of  the  visiting  magistrates. 
He  sends  that  notice  of  admission  accompanied  by  copies  of  the 

'  Some  measure  of  responsibility  attaches  also  to  the  certifying  medical 
man.  In  the  case  of  Hall  v.  Semple,  decided  in  1S62,  the  plaintiff  obtained 
a  verdict  for;,^i50  damages  against  the  defendant,  a  medical  man  who  "  neg- 
ligently and  culpably  "  signed  a  certificate  for  admission  to  a  jirivate  asylum. 


30  ENGLAND. 

order  and  of  the  two  certificates  under  which  the  patient  was  ad- 
mitted, and  he  must  at  the  same  time  make  an  entry  in  his  admis- 
sion-book of  the  patient's  reception  ;  then  after  two  days,  and 
within  seven  clear  days  from  the  reception  of  the  patient,  the 
medical  attendant,  whoever  he  may  be  (either  the  medical  super- 
intendent  of  the  hospital,  or  asylum,  or  the  proprietor  of  the 
licensed  house  himself,  if  a  medical  man),  but  in  any  case  the  per- 
son who  has  the  medical  charge  of  the  patients  in  the  house  or 
asylum,  must  send  up  to  the  Commissioners  in  Lunacy  what  is 
really  a  third  certificate,  stating  what  the  patient  is  as  to  his  men- 
tal and  bodily  condition.  It  is  filled  up  by  different  medical  su- 
perintendents with  more  or  less  particularity  ;  some  of  them  fill 
up  the  form  very  fully  and  carefully,  and  give  a  great  deal  of  in- 
formation with  reference  to  the  patient  ;  some  fill  up  the  form 
by  stating  that  the  patient  is  laboring  under  "  mania  "  or  "  demen- 
tia "  as  the  case  may  be.  The  words  are  :  "  I  have  this  day  seen 
and  examined  the  patient  mentioned  in  the  above  notice,"  that  is 
the  notice  of  admission,  "  and  hereby  certify  that  with  respect  to 
mental  state  he  (or  she)  "  is  so  and  so,  "  and  that  with  respect  to 
bodily  health  and  condition,  he  (or  she)"  is  so  and  so. 

With  regard  to  the  amendment  of  certificates  or  orders,  which 
may  not  appear  to  the  commissioners  to  be  in  proper  form,  the 
nth  section  of  the  Act  i6  and  17,  Vict,  reads  as  follows  :  "If 
after  the  reception  of  any  lunatic  it  appear  that  the  order  or  med- 
ical certificate,  or  (if  more  than  one)  both  or  either  of  the  medi- 
cal certificates,  upon  which  he  was  received,  is  or  are  in  any  re- 
spect incorrect  or  defective,  such  order  and  medical  certificate  or 
certificates  may  be  amended  by  the  person  signing  the  same  at 
any  time  within  fourteen  days  after  the  reception  of  such  lunatic  : 
provided,  nevertheless,  that  no  such  amendment  shall  have  any 
force  or  effect  unless  the  same  shall  receive  the  sanction  of  one  or 
more  of  the  commissioners."  That  was  extended  a  little  further 
in  1862  by  the  27th  section  of  the  25  and  26  Vict.  c.  in,  which 
said  :  "  Where  any  medical  certificate  upon  which  a  patient  has 
been  received  into  any  asylum,  registered  hospital,  licensed  or 
other  house,  or  either  of  such  certificates  is  deemed  by  the  com- 
missioners incorrect  or  defective,  and  the  same  are  or  is  not 
duly  amended  to  their  satisfaction  within  fourteen  days  after  the 
reception,"  then  the  commissioners  may  make  an  order  for  his 
discharge.  A  superintendent  or  jjroprietor  of  a  house  would  be 
safe  in  taking  a  patient  if  upon  the  face  of  the  documents  there 


DISCHARGE.  3 1 

was  no  very  gross  and  palpable  omission,  such  as  no  facts  stated 
to  have  been  observed  by  the  medical  man  himself,  or  a  false 
signature  to  the  order. 

A  relieving  officer  or  overseer  is  bound,  under  heavy  penalties, 
to  remove  every  pauper  lunatic,  or  every  lunatic  not  under  proper 
care  and  control,  whether  a  pauper  lunatic  or  not,  whom  he  finds 
or  has  notice  of  in  his  district.  That  is  under  the  provisions  of 
the  16  and  17  Vict.  c.  97,  which  is  the  great  Act  regulating  all 
lunatic  asylums  and  pauper  lunacy,  sections  67  and  68.  Section 
67  imposes  upon  the  relieving  officer  and  medical  officer  of  the 
parish  or  union  the  duty  of  removing  pauper  lunatics  to  an  asy- 
lum, and  section  68  refers  to  lunatics  wandering  at  large  and  not 
properly  taken  care  of,  or  cruelly  treated,  and  not  under  proper 
care  and  control.  In  the  case  of  paupers  the  order  is  the  order  of 
the  magistrates,  not  being  a  mere  request,  but  an  actual  order  to 
the  superintendent  of  the  asylum  to  take  the  patient  in.  It  is  ac- 
companied by  a  statement  signed  by  the  relieving  officer,  saying 
what  union  the  chargeability  rests  primarily  upon,  and  it  is  ac- 
companied by  a  certificate  which  is  in  precisely  the  same  form  as 
a  private  certificate,  with  the  exception  that  it  omits  the  words 
relating  to  a  separate  examination,  because  there  is  only  one 
certificate.  Another  difference  is  that  the  notice  of  admission  is 
not  sent  to  the  commissioners  within  twenty-four  hours,  as  is  the 
case  with  a  private  patient,  but  within  seven  days.  The  medical 
superintendent  of  the  asylum  sends  up  his  statement  of  condition 
along  with  the  notice  of  admission  of  the  pauper  patient,  which 
is  signed  by  the  clerk  of  the  asylum  on  some  day  after  two  days 
and  within  seven  days  after  the  admission.  The  medical  certifi- 
cate lasts  till  the  discharge  of  a  patient. 

On  the  recovery  of  any  private  patient,  notice  must  be 
given  to  the  person  who  signed  the  order  of  admission,  or 
to  the  one  by  whom  the  last  payment  was  made  ;  and  if  the 
patient  be  not  removed  within  fourteen  days,  notice  must 
then  be  given  to  the  commissioners,  and  in  the  case  of  a 
house  licensed  by  justices,  to  the  visitors  also.  An}-  patient, 
not  a  pauper,  may  be  discharged  or  removed,  whether  recov- 
ered or  not,  by  the  order  in  writing  of  the  person  who  signed 
the  order  of  admission,  or  in  the  event  of  his  death  or  inca- 


32  ENGLAND. 

pacity,  by  that  of  some  other  person  authorized  to  act  in 
his  stead,  unless  the  medical  officer  in  charge  object  to  the 
patient's  removal  on  the  ground  that  he  is  dangerous  and 
unfit  to  be  at  large,  in  which  case  the  consent  of  the  com- 
missioners or  visitors  must  be  obtained  for  his  discharge  or 
removal  ;  though  he  may  be  transferred,  under  the  control 
of  an  attendant,  to  some  other  establishment.  If  there  be 
no  relative  or  other  person  qualified  to  order  the  removal  or 
discharge,  the  commissioners  may  do  so. 

The  commissioners  are  also  empowered  to  effect  the  dis- 
charge of  private  patients  for  two  reasons:  one  for  the  in- 
sufficiency of  certificates,  if  after  commitment  they  are  still 
deemed  insufficient ;  and,  secondly,  if  two  of  the  commis- 
sioners visiting  at  intervals  of  seven  days,  and  with  certain 
formalities  prescribed  by  the  Act,  come  to  the  conclusion, 
that  any  person  held  there,  to  whom  their  visits  are  specially 
directed,  is  detained,  in  the  terms  of  the  Act,  without  suf- 
ficient cause.  "The  Commissioners,"  to  use  the  words  of 
Secretary  Perceval,  "  from  their  own  observations,  some- 
times think  that  a  patient  ought  to  be  allowed  to  go,  and 
their  friends  sometimes  think  that  it  is  not  time  that  they 
should  be  discharged.  It  is  more  in  the  case  of  pauper 
patients  that  we  hear  these  complaints  than  in  the  case  of 
private  patients.  A  near  relation  wishes  to  get  the  bread- 
winner of  the  family  out  of  the  asylum,  or  the  husband 
wants  to  get  his  wife  back,  because  he  finds  it  very  uncom- 
fortable to  be  living  without  her,  and  he  wishes  her  to  be 
discharged  whether  she  is  quite  cured  or  not.  These  are 
the  kind  of  complaints  we  get  in  much  larger  number  than 
those   relating  to  the  undue  detention  of  private   patients." 

The  committees  of  visitors  entrusted  with  the  local 
management  of  county  and  borough  asylums  may  dis- 
charge a  patient,  whether  recovered  or  not,  on  the  recom- 


TRANSFER.  33 

mendation  of  the  superintendent,  or  they  may  do  so  of 
their  own  authority  and  against  the  wish  of  the  medical 
superintendent,  provided  three  of  said  visitors  concur. 
Generally,  however,  they  act  on  the  recommendation  of  the 
medical  superintendent.  The  commissioners  have  no  power 
of  discharge  in  the  case  of  paupers,  other  than  for  insuffi- 
ciency of  certificate.  They  may,  however,  recommend  dis- 
charge for  other  reasons. 

Pauper  patients  (not  dangerous)  in  licensed  houses  and 
hospitals  may  be  discharged  therefrom  by  the  Board  of 
Guardians  of  any  parish  or  union,  or  an  officiating  clergy- 
man of  any  parish  not  under  a  Board  of  Guardians,  with  one 
of  the  overseers  thereof,  or  any  two  justices  of  the  county 
or  borough  in  which  such  last-mentioned  parish  is  situate. 

The  commissioners  frequently  advise  the  transfer  of  a  pa- 
tient where  there  is  a  difference  of  opinion  between  them 
and  the  superintendent  of  a  hospital  or  licensed  house  as  to 
the  necessity  of  confinement.  The  Home  Secretary  may 
discharge  absolutely  or  conditionally  any  criminal  lunatic. 

In  1877,  ^i^  important  investigation  was  made  by  a  select 
committee  of  the  House  of  Commons,  into  the  operation  of 
the  lunacy  laws  so  far  as  regards  the  security  afforded  by 
them  against  violations  of  personal  liberty.  The  inquiry 
was  particularly  directed  to  what  are  known  as  "  private 
asylums  ";  viz.,  thirty-nine  metropolitan  and  sixty-one  pro- 
vincial licensed  houses  kept  by  their  proprietors  for  profit. 
Some  grave  charges  were  advanced  against  these  private  es- 
tablishments, but  with  no  very  definite  result.  It  was  shown, 
that  English  forms  of  commitment  were  susceptible  of,  and 
indeed  required,  amendment ;  yet  it  was  decided  that  no 
abuses  of  personal  liberty  were  clearly  established  by  the 
evidence.  The  committee,  in  reporting  on  the  evidence, 
expressed    the    opinion    that    frequent    and    careful    visita- 


34  ENGLAND. 

tion  is  the  surest  mode  of  guarding  against  unduly  pro- 
longed detention,  and  advised  the  more  general  adoption  of 
probationary  discharge,  with  full  power  in  the  hands  of  the 
commissioners  to  order  discharge.  It  was  stated  before 
the  committee,  that,  since  1845,  there  had  not  been  more 
than  ten  cases  of  discharge  effected  by  the  commissioners 
under  the  76th  section  of  8  and  9,  Vict.  c.  100,  which  pro- 
vides, that,  if  a  patient  is  to  be  discharged,  and  the  person 
who  signed  the  order  is  contumaciously  unwilling  to  dis- 
charge him,  two  of  the  commissioners  may  examine  the 
patient,  and,  after  two  separate  visits,  with  an  interval  of 
seven  days  between  the  visits,  may  discharge  him  from 
confinement.  Although  it  may  be  true  that  only  ten  dis- 
charges were  effected  in  this  way,  nevertheless,  it  will  be 
seen  from  the  following  testimony  of  the  late  Chairman  of 
the  Lunacy  Commission,  before  the  parliamentary  commit- 
tee just  referred  to,  that  the  moral  effect  of  this  law  has  made 
the  commissioners  instrumental  in  releasing  large  numbers  : 

"  In  going  the  round  of  our  different  houses  we  saw  a  number 
of  patients  whom  we  thought  in  a  fair  way  of  recovery,  and  who 
might  safely  be  taken  out,  or  who  at  least  should  have  a  chance 
of  recovering  by  the  benefit  of  a  change,  and  who  should  be  so 
treated  by  their  friends.  We  used,  as  we  do  now,  to  enter  obser- 
vations of  that  sort  in  the  Patients'  Book.  The  friends  see  those 
entries,  and  in  a  vast  number  of  instances,  nay,  almost  in  all,  act 
upon  them.  We  have  been  in  the  habit  of  writing  to  the  relatives 
of  the  patient,  or  the  person  who  signed  the  order,  using  this  argu- 
ment :  You  must  be  perfectly  aware  that  there  is  a  sore  place 
between  you  and  the  patient.  You  have  signed  the  order,  and 
you  have  put  him  in  confinement.  It  is  very  necessary  that  we 
should,  if  possible,  keep  up  harmony  in  families.  Will  you  have 
the  grace  to  take  the  person  out  ?  If  you  do  not  do  it,  we  shall 
be  obliged  to  resort  to  our  powers  of  liberation  ;  but  we  think  it 
is  far  better  that  the  liberation  should  come  from  another  quar- 
ter, from  the  friends  themselves,  and  it  will  perhaps  heal  a  sore 
place   and    restore    kind   feelings.      The   result   has    been  that 


PROLONGED  DETENTION.  35 

scarcely  ever  any  resistance  is  made  ;  our  advice  is  attended  to, 
and  hundreds  and  thousands  are  constantly  liberated  upon  that 
principle.  We  gave  leave  of  absence  during  the  year  1876,  in 
the  metropolitan  licensed  houses,  to  614  persons  ;  of  these,  131 
never  came  back  ;  we  never  inquired  after  them,  and  were  very 
glad  that  they  did  not  return  to  the  asylum.  The  same  thing  has 
been  going  on  in  the  provincial  asylums,  both  in  licensed  houses 
and  in  the  county  asylums,  and  in  the  hospitals  ;  and  in  that  way 
a  great  number  of  persons  have  been  set  at  liberty,  and  have  never 
returned  to  confinement.  A  great  many  go  out  on  trial,  and  the 
trial  has  proved  effective  in  many  cases.  Some  have  come  back, 
some  have  not  come  back  ;  and  thus  many  have  regained  their 
freedom." 

Notwithstanding  the  above  statement  by  so  distinguished 
an  authority,  respecting  the  favorable  operation  of  the  Eng- 
lish lunacy  laws,  it  would  appear  that  they  do  not  suffi- 
ciently guard  against  the  abuse  of  unnecessarily  prolonged 
asylum  detention.  The  Commissioners  in  Lunacy  in  report- 
ing upon  the  Colney  Hatch  asylum  in  1879,  ^^i*^  • 

"  During  our  visit  on  this  occasion  the  complaints  of  unneces- 
sary detention  are  unusually  numerous,  and  very  numerous  also 
are  the  complaints  in  both  divisions  that  access  by  the  patients 
to  any  but  the  medical  staff  is  practically  denied.  Of  course  we 
cannot  affirm  the  insanity  of  all  the  patients  ;  neither  is  it  our 
province  to  consider  the  discharge  of  any  ;  but  these  complaints 
are  made  to  us.  We  earnestly  trust  that  the  members  of  the  Com- 
mittee whose  duty  it  is  to  visit  periodically  the  wards  do  make 
those  visits  real  opportunities  for  listening  to  the  patients,  hear- 
ing their  grievances,  and  reporting  thereon  to  their  colleagues  in 
view  to  remedy  any  cause  of  complaint.  Many  patients  in  each 
division,  especially  on  the  women's  side,  have  told  us  that  they 
know  the  chairman  by  sight  and  are  well  acquainted  with  the 
medical  officers  ;  but  by  no  means  few,  who  have  been  in  the  asy- 
lum a  long  period,  and  who  do  not  lack  intelligence,  informed  us 
that  they  knew  not  that  they  were  visited  at  intervals  by  members 
of  the  Committee  for  inquiry  into  their  cases.  Some,  indeed,  knew 
that  they  were  periodically  counted  in  the  wards,  but  denied  that 
they  had  then  such  opportunity  as  they  desired  for  complaint. 


36  ENGLAND. 

In  another  direction  we  would  also  suggest  whether  assistance 
could  not  be  given  to  the  medical  staff.  We  allude  to  the  dis- 
charge of  cases  '  relieved  '  only.  This  must  be  often  a  difificult 
question,  and  must  largely  depend  upon  the  amount  of  care  and 
protection  which  can  be  secured  for  the  discharged  through  their 
relatives.  Looking  at  the  vast  number  of  patients,  we  think  that 
the  Committee  should  consider  whether  some  system  of  inquiry 
could  not  be  organized  which  might  relieve  the  medical  staff  of 
labor  in  this  direction.  The  medical  superintendents  have  cer- 
tainly no  leisure,  and  the  task  of  inquiry  into  the  circumstances 
of  a  patient  if  discharged  as  relieved  might  possibly  be  undertaken 
by  members  of  the  Committee  in  rotation,  assisted  by  a  clerk. 
The  result  would  doubtless  be  a  diminution  of  the  crowd  detained 
here,  a  boon  to  the  partially  recovered,  and  an  economy," 

The  commissioners  in  again  reporting  on  this  asylum  in 
1886,  said  : 

"  We  had  a  great  number  of  complaints  as  to  undue  deten- 
tion, and  we  referred  all  the  patients  to  the  Committee,  telling 
them  that  they  alone  had  absolute  power  of  discharge.  We  learn 
that  the  Committee  go  round  once  every  two  months,  but  some 
of  the  patients  told  us  they  were  denied  speech  with  them  ;  but 
this  we  trust  is  not  the  case.  The  patients  also  complained  that 
the  guardians  from  some  of  the  unions  never  came  to  see  them, 
and  this  complaint  we  learn  is  well  founded,  and  have  to  express 
a  hope  that  the  Committee  will  urge  on  the  various  boards  who 
neglect  their  duty  in  this  respect  the  desirability  of  making  visits 
to  their  patients  at  certain  tim.es." 

As  much  interest  attaches  to  the  practice  of  liberating 
patients  "on  trial,"  it  may  be  well  to  give  a  few  details 
on  this  point.  By  the  Act  of  1845,  it  was  made  lawful 
for  the  proprietor  or  superintendent  of  any  licensed 
house,  or  of  any  hospital,  with  the  consent  in  writing  of 
any  two  of  the  commissioners,  or  in  the  case  of  a  house 
licensed  by  justices,  of  any  two  of  the  visitors  of  such 
house,  to  send  or  take,  under  proper  control,  any  patient  to 
any  specified  place  for  any  definite  time  for  the  benefit  of 


ABSENT  ON   TRIAL.  37 

liis  health.  The  consent  of  the  committing  party  was  then 
deemed  essential,  unless  for  special  reasons  the  commission- 
ers or  visitors  dispensed  with  such  consent.  In  1855,  legis- 
lation empowered  the  superintendent  of  any  registered  hos- 
pital, with  the  written  sanction  of  any  two  of  his  committee 
of  management,  to  effect  the  removal  of  any  patient  on  trial. 
In  1862,  power  was  conferred  on  the  commissioners,  on  com- 
mittees of  governors,  and  on  boards  of  vistors,  of  their  own 
authority,  to  permit  pauper  patients  to  be  absent  on  trial. 
The  words  of  the  section  are  as  follows  : 

"  Two  of  the  Commissioners,  as  regards  any  hospital  or  any 
licensed  house,  and  two  of  the  committee  of  governors  of  any 
hospital,  and  two  of  the  visitors  of  any  licensed  house, 
as  regards  any  licensed  house  within  the  jurisdiction  of 
visitors,  may  of  their  own  authority  permit  any  pauper  pa- 
tient therein  to  be  absent  from  such  hospital  or  house  upon 
trial  for  such  period  as  they  may  think  fit,  and  may  make 
or  order  to  be  made  an  allowance  to  such  pauper  not  exceeding 
what  would  be  the  charge  for  him  in  such  hospital  or  house,  which 
allowance  shall  be  charged  for  him  and  be  payable  as  if  he  were 
actually  in  such  hospital  or  house,  but  shall  be  paid  over  to  him, 
or  for  his  benefit,  as  the  said  Commissioners  or  visitors  may  di- 
rect. In  case  any  person  so  allowed  to  be  absent  on  trial  for  any 
period  do  not  return  at  the  expiration  thereof,  and  a  medical  cer- 
tificate as  to  his  state  of  mind  certifying  that  his  detention  as  a 
lunatic  is  no  longer  necessary  be  not  sent  to  the  proprietor  or 
superintendent  of  such  licensed  house  or  hospital,  he  may  at  any 
time  within  fourteen  days  after  the  expiration  of  the  said  period 
be  retaken,  as  in  the  case  of  an  escape." 

The  system  of  visitation  by  the  Commissioners  in  Lunacy 
is  as  follows  :  The  districts  beyond  the  metropolitan  area 
are  arranged  into  nine  circuits,  which  are  divided  between 
six  commissioners,  alternating  half-yearly  in  their  circuits. 
All  of  the  asylums,  licensed  houses,  hospitals,  and  single 
patients  are  visited  by  the  commissioners  every  }'ear — some 
of  them  twice  a  year,  or  oftencr.     Workhouses  with  lunatic 


38  ENGLAND. 

wards  are  visited  annually.  The  smaller  workhouses  con- 
taining lunatics  are  visited  once  in  three  years.  The  metro- 
politan district  is  divided  into  six  circuits,  visited  four  times 
a  year  by  two  commissioners,  and  twice  a  year  by  one  com- 
missioner, making  six  visits  in  the  course  of  the  year,  besides 
frequent  special  visits  in  special  cases.  The  work  of  the 
Lunacy  Commission  is  at  present  performed  by  three  un- 
paid and  six  professional  and  paid  commissioners  and  a 
secretary.  The  latter  is  assisted  by  a  large  stafT  of  perma- 
nent clerks.  The  paid  commissioners,  three  of  whom  must 
be  physicians  and  three  barristers,  receive  a  salary  of  ;^I,5CX> 
each,  and  the  secretary  is  paid  ^800  a  year.  Appointed 
by  the  Lord  Chancellor  for  chancery  cases  are  two  Masters 
(or  judges)  in  Lunacy,  who  are  salaried  at  ^2,000  each  per 
annum.  There  are  also  appointed  by  the  Lord  Chancellor 
three  special  Visitors  receiving  each  ^1,500  per  annum. 
They  visit  about  1,000  lunatics,  of  whom  one  third  are  in 
private  dwellings  and  the  rest  in  asylums.  The  annual  ex- 
penditures in  connection  with  the  Lunacy  Commission  and 
the  Chancery  and  Registrar's  department  for  lunatics  exceed 
$200,000.  This  is  exclusive  of  the  cost  of  visitation  by  the 
inspectors  of  the  Local  Government  Board,  who  supervise 
workhouses  and  outdoor  paupers,  and  are  salaried  at  from 
^600  to  ^1,000  each.  It  is  also  exclusive  of  the  cost  of 
visitations  by  local  authorities. 

The  number  and  distribution  of  lunatics  in  England  and 
Wales  on  the  ist  of  January,  1887,  according  to  statistics 
collected  by  the  Lunacy  Board,  is  shown  in  the  table  on 
the  following  page. 

The  figures  given  do  not  include  "  249  lunatics  so  found 
by  inquisition,  living  in  the  immediate  charge  of  their  com- 
mittees, and  69  male  prisoners  who  have  become  insane  while 
undergoing  sentences   of  penal   servitude  and  who  are  de- 


GOVERNMENT  GRANT. 


39 


tained  in  convict  prisons."  Since  1884,  criminal  lunatics 
have  been  provided  for  by  moneys  appropriated  by  Parlia- 
ment. 


Where  Maintained  on 

Private. 

Pauper. 

Criminal. 

January  i,  1887. 

M. 

F. 

T. 

M.      1      F.      1      T. 

Vl.  1    F.  1  T. 

Total. 

In   County  and  Bor- 

ough Asylums  . 

368 

425 

793 

21,587 

26,357 

47,944 

84 

21 

105 

48,842 

In  Registered  Hospi- 

tals      

1,608 

1,489 

3,097 

103 

60 

163 

3,260 

In  Licensed  Houses: 

Metropolitan 

861 

787 

1,648 

287 

507 

794 

2,442 

Provincial. 

691 

847 

1,538 

152 

200 

352 

5 

5 

1,895 

In  Naval   and   Mili- 

tary Hospitals  and 

Royal    India  Asy- 

lum      

259 

20 

279 

279 

In  Criminal   Lunatic 

Asylum       (Broad- 

moor)  

392 

139 

531 

531 

In  Workhouses  : 

Ordinary  Work- 

houses. 

5,217 

6,765 

11,982 

11,982 

Metrop  0  1  i  ta  n 

District  Asylums 

2,501 

2,89s 

5,399' 

5,399 

Private     Single     Pa- 

tients   .... 

1S6 

266 

452 

452 

Outdoor  Pauper  Lu- 

natics. 

2,308 

3,501 
40,288 

5,809' 

5,809 

Total      .      . 

3,973 

3,834 

7,807 

32,155 

72,443 

4S_i 

160 

(H^ 

So,8gi 

From  this  table,  it  will  be  seen  that  there  were  11,982 
lunatics  in  "  ordinary  workhouses."  As  these  include  a  very 
large  number  of  the  idiot  class,  the  number  of  insane  who 
are  debarred  from  asylum  care  is  not  so  large  as  at  first  ap- 
pears. In  1874  the  State  took  a  memorable  step  in  grant- 
ing four  shillings  a  week  towards  the  maintenance  of  every 
pauper  lunatic  placed  under  asylum  care.  This  grant,  de- 
signed to  improve  the  treatment  of  the  insane,  does  not  in 
England  or  Ireland  extend  outside  of  asylums.  In  Scotland, 
however,  it  is  applied  to  the  insane  departments  of  poor- 
houses,  provided  the  accommodation  is  approved  by  the 
Scotch  Board  of  Lunacy.  The  effect  of  the  grant  has  been 
to   draw   into  asylums   many  chronic   cases   that    were  for- 


40  ENGLAND. 

merly  restricted  to  the  inferior  accommodations  of  work- 
houses. 

What  are  termed  in  the  foregoing  table  "  private  single 
patients"  include  lunatics  of  almost  every  class  except  desti- 
tute paupers.  They  are  kept  not  only  by  persons  of  the 
medical  profession,  but  by  others  ;  in  a  number  of  cases 
by  women,  some  of  whom  have  acquired  in  asylums  or 
elsewhere  a  knowledge  of  mental  disease.  The  price  paid 
for  maintenance  and  care  varies  from  a  pound  a  week  up  to 
several  hundred  pounds  a  year,  according  to  accommo- 
dation, medical  and  other  attendance. 

The  "  outdoor  pauper  lunatics,"  numbering  5,809,  are  those 
who  are  harmless  and  do  not  require  treatment  in  an  asylum, 
hospital,  or  licensed  house  ;  and  instead  of  being  sent  to  the 
workhouse  are  left  under  the  care  of  relatives  or  friends  and 
receive  a  certain  allowance  from  the  poor-law  guardians  for 
their  maintenance. 

The  relation  which  outdoor  pauper  lunatics  hold  to  the 
Lunacy  Board  is  thus  explained  by  Secretary  Perceval : 
"  Pauper  lunatics  in  private  dwellings  are,  as  a  rule,  left  to 
the  visitation  of  the  district  medical  officer.  This  official 
and  the  relieving  officer  are  supposed  to  be  the  supervisors 
of  those  patients,  and  the  medical  officer  is  bound  to  visit 
them  once  a  quarter.  He  has  a  fee  of  half  a  crown  for 
doing  so,  and  he  reports  through  the  clerks  of  unions  to  the 
guardians,  and  to  the  Commissioners  in  Lunacy,  the  names 
of  all  the  outdoor  lunatic  paupers  visited  by  him  during  the 
quarter.  Those  lists  come  up  and  are  examined  at  the 
Commissioners'  office,  and  inquiries  are  very  frequently 
directed  when  it  appears  from  the  medical  man's  report  that 
the  condition  of  the  patient  is  unsatisfactory.  The  medical 
officer  is  obliged  to  put  a  certificate  at  the  bottom  of  his 
return  to  the  effect  that  he   has   seen  and  examined  all  the 


METROPOLITAN   CHRONIC  INSANE.  4 1 

above-named  patients."  The  commissioners  have  no  direct 
control  over  pauper  patients  boarded  out  ;  they  can  only 
advise  respecting  their  proper  disposal  and  care. 

It  will  be  seen  by  the  table  that  5,399  lunatics  are  in  the 
"  Metropolitan  District  Asylums,"  of  which  there  are  three, 
namely,  Caterham,  Leavesden,  and  Darenth.  The  first  two 
are  exclusively  for  the  chronic  insane,  and  at  the  last 
are  schools  for  idiot  children.  These  asylums  are  under 
the  control  of  the  Metropolitan  Asylums  Board,  which  con- 
sists of  rate-paying  managers,  not  more  than  one  third  of 
whom  are  appointed  by  the  Local  Government  Board.  The 
remainder  are  elected  by  the  guardians  of  the  poor  in  the 
metropolis.  The  Metropolitan  Board  was  designed  to 
bring  about  a  better  classification  of  the  dependent  classes 
by  removing  the  insane  from  overcrowded  and  ill-adapted 
workhouses  to  specially  constructed  institutions  in  the 
country,  with  farms  adjoining,  and  with  medical  and  other 
supervision  suited  to  their  requirements.  This  consolida- 
tion of  authorities  into  one  central  board  has  furnished  a 
striking  illustration  of  the  power  of  combination  ;  for  by  this 
means  has  been  accomplished,  in  regard  to  the  chronic 
insane  of  London,  a  great  and  humane  work,  which  could 
never  have  been  performed  singly  by  any  of  the  local  bodies 
now  represented  on  the  Board. 

The  three  "Metropolitan  District  Asylums"  are  tech- 
nically regarded  as  workhouses  within  the  meaning  of  the 
Act  of  Parliament,  and  receive  only  incurable  cases,  or 
those  not  dangerous  to  themselves  or  others.  Like  ordi- 
nary workhouses,  they  come  more  under  the  control  of 
the  Local  Government  Board  (formerl)-  the  Poor  Law- 
Board)  than  under  the  Commissioners  in  Lunacy.  The 
latter  may  make  recommendations,  but  the  Local  Govern- 
ment  Board  directs,   in   such  establishments. 


42  ENGLAND. 

By  an  Act  passed  in  1862,  the  committees  of  visitors 
having  the  charge  of  county  and  borough  asylums,  and  the 
boards  of  guardians  of  workhouses,  with  the  consent  of  the 
Lunacy  Commissioners  and  the  President  of  the  Poor  Law 
Board,  were  empowered  to  arrange  for  the  reception  into 
workhouses  of  a  Hmited  number  of  chronic  lunatics.  This 
power  was  intended  to  meet  the  wants  of  localities  where 
there  was  not  sufificient  asylum  accommodation  for  "  recent 
and  curable  cases,"  and  where  the  workhouse  could  be  certi- 
fied to  have  the  requisite  accommodation  for  chronic  cases  ; 
such  accommodation  to  include  a  liberal  dietary,  ample 
means  of  outdoor  exercise,  medical  visitation,  paid  assistants 
and  proper  nurses. 

A  further  measure,  passed  in  1868  with  similar  intent,  pro- 
vided that  any  chronic  lunatic  transferred  from  an  asylum  to 
a  workhouse  should  continue  a  patient  on  the  books  of  the 
asylum  "  for  and  in  respect  of  all  the  provisions  in  the  Lu- 
nacy Acts,  so  far  as  they  relate  to  lunatics  removed  to 
asylums."  But,  according  to  Mr.  Henley,  one  of  the  Local 
Government  Board's  inspectors,  this  attempt  to  relieve 
overcrowded  asylums  has  proved  a  failure,  for  the  following, 
among  other  reasons  :  A  patient  under  this  law,  though 
transferred  to  a  workhouse,  would  remain  an  asylum  patient 
subject  to  visitation  by  the  asylum  superintendent,  who 
micrht  [?ive  orders,  and  thus  introduce  a  sort  of  dual  man- 
agement  within  the  workhouse,  imperilling  both  harmony 
and  efficiency.  The  parties  concerned  in  the  new  ar- 
rangement embraced  four  different  and  overlapping  au- 
thorities ;  viz.,  the  Commissioners  in  Lunacy,  the  Local 
Government  Board,  the  Board  of  Guardians,  and  the  Com- 
mittee of  Visitors.  The  commissioners  very  properly  in- 
sisted on  standard  requirements  for  the  insane,  and  the 
presence  of  so  many  different  elements  led  to  the  practical 
abandonment  of  the  measure. 


COST  OF  MAINTENANCE.  43 

The  law  prohibits  the  retention  in  workhouses  of  any 
pauper  lunatic  who  is  dangerous  or  who  requires  restraint. 
The  Local  Government  Board,  as  the  leading  central 
authority  of  the  State  in  poor-law  matters,  is  the  supreme 
authority  in  the  government  of  workhouses.  The  Commis- 
sioners in  Lunacy,  in  the  exercise  of  their  powers  of  visita- 
tion, may,  however,  order  any  lunatic  to  be  received  into  any 
borough  or  county  asylum,  or  into  any  registered  hospital  or 
licensed  house,  if  it  appears  to  them  that  the  case  is  not  a 
proper  one  for  the  workhouse.  The  appeal  of  the  guardians 
against  such  order,  if  made  at  all,  must  be  made  to  the 
Home  Secretary.  Reports  of  all  workhouse  visitations,  giv- 
ing details  of  the  condition  of  the  inmates,  their  dietary, 
general  treatment,  etc.,  are  submitted  to  the  Local  Gov- 
ernment Board,  the  Lunacy  Commissioners  making  any 
recommendations  they  see  fit. 

It  will  be  seen  from  the  foregoing  table  that  sixty  per 
cent  of  all  the  lunatics  of  England  and  Wales  under  cogni- 
zance of  the  Lunacy  Board  are  provided  for  in  county  and 
borough  asylums,  the  average  weekly  per -capita  cost  of 
maintenance  in  which,  during  the  year  1886,  was  as  fol- 
lows : 

s.'        d. 
County  Asylums  .         .         .         .8         7^ 

Borough  Asylums  .         .         .         .9         y-g- 

These  averages  include  provisions,  medicines,  clothing, 
salaries  and  wages,  furniture  and  bedding,  and  household 
requisites  ;  and  in  some  of  the  borough  asylums  are  also  in- 
cluded ordinary  repairs  of  buildings,  which  is  the  principal 
reason  of  the  higher  average  cost  in  these  institutions. 

The  average  annual  increase  among  pauper  lunatics  during 
the  past  twenty  years  has  been    1,470,  the   increase   being 

'One   shilling   sterling   is    equivalent   to    about   24    cents  in   United  States 


44 


ENGLAND. 


greater  than  the  proportionate  increase  in  the  population. 
It  is  to  be  noted,  however,  that  this  increase  cannot  be  at- 
tributed to  a  greater  proportion  of  paupers  ;  for  statistics 
show  that  on  the  ist  of  January,  1867,  of  the  population, 
4.44  per  cent  were  paupers,  and  on  the  1st  of  January,  1887, 
only  2.91  per  cent  were  paupers.  In  the  opinion  of  some 
authorities,  this  increase  in  the  number  of  pauper  lunatics  is 
not  so  much  due  to  an  increase  of  fresh  insanity  as  to  the 
annual  accumulation  of  patients  under  treatment  which 
favors  longevity. 

The  subjoined  statistics,  from  of^cial  returns,  serve  to 
illustrate  the  proportion  of  lunatics  and  paupers  to  the 
population  in  the  years  1867  and  1887. 


Year. 

Lunatics  of      ;           Pauper 
All  Classes,     i        Lunatics. 

Paupers.^ 
(Sane  and  In- 
sane.) 

Population. 

1867 

1887 

49,086                  43,031 
80,891'                  72,443 

963,200 
822,215 

21,677,525 
28,247,151 

It  will  be  seen  from  the  above  figures  that,  of  the  lunatics, 
there  was  i  to  every  441  of  the  population  in  1867,  and 
I  to  every  349  in  1887  ;  and  of  the  pauper  lunatics  there 
was  I  to  504  of  the  population  in  1867,  and  i  to  389  in  1887. 

Having  sketched  the  salient  points  of  the  English  lunacy 
system,  and  shown  the  classification  and  distribution  of  the 
insane,  also  the  cost  of  their  maintenance,  descriptions  of 
some  of  the  English  asylums  will  now  be  given,  attention 
being  directed,  with  one  exception — the  York  Retreat — to 
those  designed  for  the  pauper  and  indigent  class.  The  at- 
tempt has  not  been  made  to  describe  fully  these  institutions, 
but  simply  to  delineate  such  features  as  would  indicate  their 
general  character. 

'  The  English  statute  defines  the  term  "  pauper  "  to  mean  a  person  "  main- 
tained wholly  or  in  part  by,  or  chargeable  to  any  union,  parish,  county,  or 
borough." 


COLNE  Y  HA  TCH.  45 

COLNEY   HATCH    ASYLUM. 

This  is  one  of  three  pauper  asylums  under  the  control  of 
the  justices  of  Middlesex — a  county  having,  according  to 
the  last  census,  2,929,678  inhabitants  and  80,109  paupers 
in  a  total  area  of  181,317  acres.  In  proportion  to  size,  this 
county  has  not  only  the  largest  population,  but  it  is  also  the 
wealthiest  portion  of  the  United  Kingdom,  yielding  a  poor- 
rate  of  upwards  of  eleven  million  dollars  per  annum.  In  its 
pauper  population  there  is  a  larger  percentage  of  lunatics 
than  in  any  other  county — one  in  seven  of  its  rate-aided 
poor  being  insane. 

The  asylum  is  situated  about  six  and  a  half  miles  north 
of  the  city  of  London,  and  it  partially  meets  the  wants  of 
that  part  of  the  metropolis  lying  north  of  the  Thames.  The 
building  is  a  large,  inexpensive  structure  of  brick,  with  slate- 
roof  and  stone  mouldings,  having  a  main  or  central  division 
of  two  and  a  half  stories,  and  wings  of  two  stories  each  to 
right  and  left.  From  the  porter's  lodge  at  the  outer  gate, 
the  approach  is  along  a  gravelled  path  leading  through  pleas- 
ant grounds.  The  estate  comprises  160  acres,  including  lawns, 
meadows,  and  gardens.  The  encircling  walls  are  hidden  by 
evergreens.  The  asylum  was  built  in  185 1,  and  is  designed 
for  acute  and,  presumably,  curable  cases,  including  the  sui- 
cidal and  dangerous.  It  accommodates  upwards  of  900  men 
and  1,300  women. 

The  Committee  of  Visitors  who  manage  the  asylum  con- 
sists of  eighteen  members.  The  administration  of  this  insti- 
tution is  somewhat  anomalous,  there  being  one  superintend- 
ent over  the  men's  and  another  over  the  women's  depart- 
ment, thus  constituting  two  entirely  separate  heads.  The 
respective  administrative  quarters  of  these  two  heads  are 
situated  nearly  at  the  extreme  ends  of  the  extensive  range 
of  buildines. 


4^  ENGLAND. 

Entering  the  portal  on  the  men's  side,  the  visitor  finds  his 
attention  drawn  to  a  tablet  recording  the  humane  act  of 
a  popular  sovereign  in  these  words  :  "  Her  Most  Gracious 
Majesty  Queen  Victoria  (whom  God  preserve)  was  pleased, 
in  her  charity,  on  the  8th  of  May,  1849,  ^o  found  the  Victo- 
ria Fund  for  the  benefit  of  poor  patients  leaving  this  asy- 
lum." The  scrupulously  clean  hall,  and  stone  stairs  scoured 
with  white  sand,  next  attract  attention.  The  interior  walls 
are  not  plastered,  but  thickly  coated  with  paint  of  a  pleasing 
tint ;  those  of  the  corridors  and  wards  are  finished  in  two 
colors,  the  dado  being  darker  than  the  upper  portion,  which 
is  relieved  by  an  ornamental  border  near  the  ceiling.  The 
various  sections  of  the  buildings  are  connected  by  long  cor- 
ridors. 

There  are  267  single  sleeping-rooms.  About  600  patients 
sleep  in  associated  dormitories  greatly  varying  in  size.  Most 
of  the  bedsteads  are  of  iron  pipe  and  supported  on  castors. 
Each  is  furnished  with  a  hair  mattress,  and  there  is  a  plenti- 
ful supply  of  blankets.  Many  have  canvas  bottoms,  which, 
by  means  of  screws  and  loops,  can  be  tightened,  or  readily 
taken  off  for  cleaning.  On  the  walls  were  pictures  and  ap- 
propriate mottoes,  while  on  the  floors  strips  of  bright  carpet 
gave  a  look  of  comfort  to  the  apartments.  In  some  of  the 
dormitories  for  the  more  quiet  class  were  large  mirrors. 

One  of  the  long  sitting-rooms  may  be  described  as  repre- 
sentative of  the  others.  It  had  tinted  walls  ornamented 
with  numerous  pictures,  and  contained  cushioned  seats,  arm- 
chairs, and  lounges.  On  the  window-sills  were  flowering 
plants  ;  ingeniously  arranged  aviaries  were  also  noted,  the 
birds  in  which  enlivened  the  room  with  song,  and,  at  the 
same  time,  amused  the  patients.  It  being  a  wintry  day, 
with  frost  and  snow,  the  inmates  seemed  greatly  to  enjoy 
the  cheerful  open  fires,  round  which  many  were  comforta- 


COLNE  Y  HA  TCH.  47 

bly  seated.  Bagatelle  boards,  chess,  draughts,  and  other 
amusements  further  diverted  attention  from  the  dreariness 
without.  The  smaller  sitting-rooms  for  the  quiet  and  con- 
valescent class  in  what  is  termed  the  day  portion  of  the 
ward  are  better  furnished  than  the  others.  Here  were  ob- 
served easy  lounges,  pianos,  billiard-tables,  books  on  centre 
tables,  carpeted  floors,  frosted  globes  to  the  gas-jets,  and  a 
profusion  of  ornamental  articles.  The  women's  side  cor- 
responds to  the  men's  in  its  general  characteristics,  except 
that  the  number  of  single  rooms  is  much  less. 

The  inmates  being  of  the  pauper  class,  they  are  under  a 
uniform  system  of  care  and  treatment.  In  the  opinion  of 
those  in  charge,  the  insane,  when  given  an  opportunity, 
effect  their  own  classification,  selecting  their  associates  by 
a  sort  of  natural  affinity.  The  violent  and  suicidal  are 
under  constant  supervision,  and  are  kept  separate  from 
others.  Patients  are  often  quieted  by  removal  from  one 
ward  to  another,  the  change  of  surroundings  having  a 
pacifying  effect.  In  the  epileptic  ward,  the  bedsteads  are 
very  low,  being  only  about  five  inches  from  the  floor,  and 
have  canvas  bottoms. 

The  women's  infirmary,  to  which  is  attached  a  separate 
dietary  kitchen,  is  furnished  with  every  requisite  comfort, 
including  rubber  mattresses  that  may  be  filled  with  either 
air  or  water  for  special  cases,  invalid  chairs,  and  cushioned 
couches  on  wheels.  The  walls  of  the  infirmary  were  deco- 
rated with  pictures  and  flowers.  On  the  floor  were  rugs 
and  strips  of  carpet,  and  the  windows  were  hung  with  scar- 
let curtains. 

There  are  three  dining-halls  for  women.  Knives  with  only 
about  an  inch  of  cutting  edge  and  common  forks  are  used 
at  table,  as  also  ordinary  white  plates  and  mugs.  At  the 
time  of  my  visit,  only  about  thirty-five  per  cent  of  the  men 


48  ENGLAND. 

were  employed.  The  weather  being  unfavorable  for  out- 
door work,  a  smaller  number  than  usual  were  occupied 
about  the  grounds.  Forty-four  per  cent  of  the  women  were 
employed.  A  majority  of  these  were  engaged  at  needle- 
work and  in  the  laundry.  All  mending  for  the  institution  is 
done  on  the  premises,  as  well  as  the  making  of  dresses, — 
plain,  useful  sewing  being  preferred  to  fancy  work.  For 
the  excitable,  washing  by  hand  is  thought  the  most  suitable 
form  of  employment.  Some  of  the  washing,  however,  is 
done  by  machinery.  The  commodious  and  well-arranged 
laundry,  with  dining,  sleeping,  day,  and  kitchen  accommoda- 
tions, is,  in  one  sense,  a  separate  department  of  the  institution. 
It  is  under  the  charge  of  a  superintendent  and  sixteen  paid 
servants.  The  appliances  here  are  complete  and  modern. 
In  separate  rooms  the  clothes  are  folded  and  ironed.  The 
laundry  is  supplied  with  several  steam-driven  mangles, 
steam-rotary  washing-machines,  and  wringers.  Clothes  were 
drying  in  the  adjoining  yard.  Many  of  the  women  were 
engaged  about  the  wards  ;  a  few  were  helping  in  the  kitchen  ; 
and  a  small  force  were  picking  the  filling  of  mattresses, 
which  is  taken  out  and  renovated  when  necessary. 

There  is  a  large  recreation  or  amusement  hall  provided 
with  piano,  orchestra  gallery,  and  stage  for  dramatic  imper- 
sonations, where  musical  and  dancing  parties  are  held. 
The  evening  entertainments  often  bring  together  assem- 
blages of  from  five  hundred  to  six  hundred  patients. 

The  airing-courts,  of  which  there  are  several,  are  large 
spaces,  with  patches  of  green  lawn,  shade  trees,  shrubbery, 
flower-beds,  and  rustic  summer-houses, — the  whole  enclosed 
by  a  sunken  wall  or  haw-haw,  thus  permitting  an  unob- 
structed view  beyond  the  grounds. 

It  was  stated  that  restraint  is  rarely  resorted  to,  and  then 
only  in  cases  of  great  destruction  of  clothing  and  for  surgic- 


COLNEY  HATCH.  49 

al  reasons.  Patients  are  commonly  secluded  in  padded 
rooms  during  paroxysms.  Of  these  rooms,  there  are  eleven 
on  the  men's  and  eight  on  the  women's  side.  The  padded 
rooms  are  each  lighted  by  barred  windows  placed  high  in 
the  wall,  and  are  lined  to  a  height  of  eight  feet  with  strong 
canvas  stuffed  to  a  thickness  of  several  inches  with  cocoa 
fibre.  The  floor  is  covered  with  a  thick  mattress  of  canvas 
similarly  stuffed.  It  was  asserted  that,  for  women,  there 
were  no  appliances  for  mechanical  restraint. 

The  attendants  average  one  to  eleven  patients.  The  men 
are  uniformly  dressed  in  blue  serge.  Each  wears  a  leathern 
belt,  to  which  is  attached  a  bunch  of  keys,  imparting  some- 
thing of  a  prison-official  character  to  the  wearer.  The 
women  wear  drab  gowns,  white  aprons  and  caps,  and  belts 
to  which  are  likewise  attached  bunches  of  keys. 

The  rooms  are  warmed  generally  by  open  fires,  in  front 
of  which  are  strong  screens.  This  form  of  heating  is  sup- 
plemented in  severe  weather  by  hot-water  pipes.  The  coal 
bins  in  the  women's  ward  are  filled  from  the  corridors 
through  traps,  thus  avoiding  intrusion. 

Under  the  windows,  as  well  as  near  the  ceiling,  slides 
were  observed  for  the  purpose  of  ventilation.  The  windows 
generally  have  iron  sashes,  with  panes  5x6  inches.  Larger 
panes  are,  however,  gradually  superseding  the  smaller  ones. 
The  upper  sashes  of  the  windows  are  made  to  open  out- 
ward. One  chimney  about  two  hundred  feet  high  suf^ces 
for  the  domestic  part  of  the  institution,  including  kitchen 
and  laundry,  smaller  flues  leading  thereto  from  the  various 
open  fires. 

An  attractive  feature  is  a  spacious  chapel,  in  which  the 
resident  chaplain  of  the  Church  of  England  officiates.  Ro- 
man Catholic  and  Jewish  services  are  also  conducted  once  a 
month — sometimes  oftener. 


50  ENGLAND. 

The  weekly  per  capita  cost  of  maintenance  here  during  the 
year  ending  January  i,  1887,  is  reported  as  9^.  3^^. 

The  general  impression  left  upon  the  mind  of  the  writer 
by  the  visit  was,  that  the  size  of  the  institution  is  incompati- 
ble with  its  curative  aims,  and  its  management  not  in  entire 
keeping  with  its  object. 

HANWELL   ASYLUM. 

This  asylum  is  famous  as  having  been  the  place  in  which, 
under  public  auspices,  Dr.  Conolly,  nearly  half  a  century  ago, 
demonstrated  the  practicability  of  the  non-restraint  principle 
in  treating  the  insane.  In  visiting  an  institution  which  had 
thus  become  historic,  one  is  actuated  by  a  strong  desire  to 
know  how  that  great  reform  has  stood  the  test  of  time. 
This  asylum  and  Colney  Hatch  receive  the  violent,  trouble- 
some, and  dangerous  cases  of  the  various  unions  or  parishes 
attached  to  the  populous  metropolitan  county  of  Middlesex. 
At  Hanwell  these  constitute  about  40  per  cent  of  the 
inmates.  Chronic  and  harmless  cases,  as  a  rule,  are  sent  to 
Banstead. 

The  building  at  Hanwell  is  situated  some  seven  miles 
northwestwardly  from  the  city  of  London.  It  is  a  plain 
brick  structure  with  slate-roof,  erected  in  1830,  and  origi- 
nally designed  for  from  300  to  400  patients,  but  since  en- 
larged to  accommodate  1,800  or  1,900.  Connected  with  the 
institution  are  loo  acres  of  land  bordering  the  river  Brent, 
and  bounded  on  the  other  three  sides  by  a  brick  wall.  Eighty 
acres  are  under  cultivation. 

In  administration,  this  asylum  presents  the  same  incon- 
gruity as  Colney  Hatch,  there  being  two  resident  medical 
superintendents. 

The  patients,  at  the  time  of  my  visit,  numbered  750  men 
and   1,100  women,  classified  according  to  their  habits    and 


HAN  WELL.  51 

peculiarities.  The  more  noisy  occupied  detached  wards. 
The  epileptics  were  in  divisions  by  themselves.  At  night 
they  are  closely  watched  by  special  attendants,  whose  move- 
ments are  marked  by  means  of  electric  clocks  that  are  af- 
fected by  every  opening  of  the  door.  The  bedsteads  for 
epileptics  are  low  and  have  canvas  bottoms.  A  detached 
building  is  used  as  a  hospital  for  infectious  diseases.  Patients 
occupying  padded  cells  are  required  to  be  visited  at  regular 
intervals  during  the  night.  There  are  on  duty  at  night  six 
male  and  twelve  female  attendants.  Throughout  the  insti- 
tution the  attendants  average  one  to  every  twelve  patients. 
They  wear  a  uniform,  that  of  the  female  nurses  being  dark 
dresses  and  white  caps.     The  patients  are  variously  attired. 

Open  fires  are  used  in  the  day-rooms  as  well  as  the  cor- 
ridors. Those  in  the  day-rooms  for  quiet  patients  are  pro- 
tected by  ordinary  fenders,  and  those  in  the  wards  for  the 
refractory  by  iron  guards.  A  complex  system  of  ventilation 
at  one  time  in  use  has  been  finally  set  aside,  open  fires  with 
direct  ventilation  from  the  windows,  and  perforations  in  the 
walls,  being  now  relied  upon,  and  the  results  are  more  satis- 
factory. Thermometers  are  hung  in  the  day-rooms  and 
corridors,  and  a  record  is  made  of  the  temperature  night  and 
morning.  In  the  dormitories,  the  rule  is  "  fresh  air  and 
plenty  of  blankets." 

On  the  male  and  female  sides.  30  per  cent  of  the  patients 
were  provided  with  single  rooms,  which  was  not  deemed  in 
excess  of  requirements  for  a  class  of  patients  many  of  whom 
are  restless  by  night.  Dormitories  on  the  upper  floor  should, 
in  Dr.  Rayner's  opinion,  have  protected  windows;  but  for 
those  on  the  ground  floor,  where  the  patients  are  under  con- 
stant supervision,  he  preferred  the  ordinary  kind. 

The  interior  walls  are  frescoed  and  appropriately  deco- 
rated— the  work   of   the  patients.     On   the  men's  side   the 


52  ENGLAND. 

furniture  appeared  abundant  and  comfortable,  including 
lounges,  easy-chairs,  and  pianos.  Pictures  on  the  walls,  and 
a  variety  of  decorative  objects  were  observed  in  the  day  and 
other  rooms.  In  some  of  the  apartments  the  windows  had 
handsome  curtains.  On  the  women's  side  the  furnishing 
was  more  elaborate.  In  one  of  the  day-rooms  was  noticed 
a  jackdaw,  a  pet  of  the  female  inmates,  which  had  been  a 
long  time  on  the  premises.  Many  inexpensive  yet  pleasing 
articles  for  adorning  the  room  had  been  made  by  the 
patients. 

The  dining-tables  are  furnished  with  table-cloths,  ordinary 
plates,  knives,  forks,  and  spoons.  Comfortable  chairs  are 
provided.  In  the  wards  for  the  excitable  cases,  the  blades 
of  the  knives  have  only  about  an  inch  of  cutting  edge.  One 
general  kitchen  supplies  the  whole  establishment.  The  tea 
is  infused,  not  boiled.  A  bag  of  tea  having  been  put  into  a 
twenty-gallon  copper  can,  boiling  water  is  then  turned  on  ; 
after  infusing  ten  minutes,  milk  and  sugar  are  added,  and  in 
five  minutes  thereafter  the  tea  is  served.  The  rule  is  twen- 
ty-three ounces  of  tea  to  twenty  gallons  of  water.  This 
method  of  making  tea,  as  may  be  inferred,  is  not  given  be- 
cause it  is  thought  to  have  special  value  as  a  recipe. 

It  is  the  aim  of  the  management  to  engage  every  patient 
at  some  kind  of  useful  employment.  Patients  are  first 
placed  under  observation  and  tested  at  an  occupation  re- 
quiring muscular  exertion.  In  cases  where  there  is  any  doubt 
about  a  patient,  employment  is  prescribed  requiring  muscu- 
lar force  without  the  agency  of  tools  capable  of  inflicting 
injury.  Working  parties  arc  examined  by  a  physician  each 
morning  before  they  go  out  to  work.  The  following  is  an 
official  statement  of  the  nature  of  the  employments  within 
the  institution  :  "  Seventy-seven  per  cent  of  the  men  and 
sixty-six  per  cent  of  the  women    are   doing  some  kind  of 


HAN  WELL.  53 

Avork.  In  outdoor  labor  280  men  are  engaged,  of  whom  183 
work  with  implements,  and  97,  who  are  less  trustworthy, 
without  tools.  Employed  in  shops  and  at  trades  are  153. 
Of  the  women,  80  assist  in  the  laundry;  12  help  in  the 
kitchen;  224  are  employed  at  needle  and  fancy  work; 
while  392  are  set  apart  for  domestic  work  in  the  female 
wards."  It  is  the  opinion  of  Dr.  Rayner,  that  patients 
spending  much  of  their  time  in  the  open  air  are  less  inclined 
to  be  suicidal.  The  theory  of  treatment  here  was  summed 
up  as  follows :  "  The  patient  should  be  well  employed  and 
allowed  plenty  of  outdoor  exercise."  "This,"  said  the  Su- 
perintendent, "  is  the  great  secret  of  successful  treatment  in 
the  care  of  the  insane." 

Respecting  mechanical  restraint,  Dr.  Rayner  made  the 
statement,  that,  in  the  treatment  of  the  insane,  he  had  never 
resorted  to  mechanical  restraint  except  by  the  use  of  gloves, 
and  that  he  used  these  only  in  exceptional  cases,  such  as  pre- 
venting a  patient  from  tearing  open  a  wound.  Neither  did  he 
use  any  chemical  restraint,  which,  in  his  opinion,  was  worse 
than  mechanical.  During  the  previous  twelve  months,  he 
thought  there  had  been  prescribed  in  this  institution  only 
twenty-four  sleeping  draughts.  He  considered  them  "  ut- 
terly pernicious."  Strong,  untearable  dresses  are  used  when 
deemed  necessary,  and  are  so  made  as  not  to  restrain  the 
limbs.  There  are  sixteen  padded  rooms  on  the  men's  side, 
and  about  a  score  on  the  women's;  and  in  these  the  floors, 
as  well  as  the  sides,  are  cushioned.  All  of  these  apartments 
may  be  readily  darkened,  the  Superintendent  believing 
darkness  to  be  desirable  for  extremely  violent  patients.  An 
attendant  is  not  allowed  to  attempt  to  handle  a  violent  pa- 
tient until  he  can  secure  the  help  of  a  posse  of  assistants  ; 
and  the  rules  are  rigid  as  to  attendants  reporting  each  in- 
stance of  resistance.     When    a    case    of  this    nature  is   an- 


54  ENGLAND. 

nounced,  a  body  of  attendants  are  immediately  sent  to  the 
spot,  and  the  patient  usually  succumbs  to  the  inevitable. 
Sometimes,  the  expedient  is  resorted  to  of  removing  an  ex- 
cited patient  to  another  part  of  the  house.  If  the  case  be 
decidedly  maniacal,  the  patient  is  placed  in  a  special  apart- 
ment in  charge  of  attendants.  In  the  space  of  twelve  months, 
seclusion  had  been  resorted  to  among  the  men  on  not  more 
than  eight  occasions,  giving  a  total  of  twenty-three  hours  ; 
and  among  the  women  ten  times,  giving  a  total  of  twenty- 
nine  hours. 

The  well-kept  airing-courts  are  quite  large.  Several  of  them 
have  about  four  acres  of  ground  each ;  in  fact,  these 
spaces  are  of  such  extent  as  to  somewhat  remove  the  im- 
pression of  restricted  boundaries,  especially  as  the  walls  and 
iron  fences  are  ingeniously  hidden  by  trees  and  shrubbery. 
It  was  a  wintry  day  on  which  my  visit  was  made,  and  it  was 
noted  with  satisfaction  that  the  men  in  the  yards  were  com- 
fortably clad,  their  clothing  including  thick  woollen  capes 
or  short  cloaks,  that  came  well  down  over  the  shoulders  and 
amply  protected  the  neck,  chest,  and  arms. 

There  is  a  large  amusement  hall,  in  which  the  patients 
hold  dancing  parties  every  Monday  evening.  In  the  sum- 
mer, lawn  tennis,  skittles,  quoits,  croquet,  and  other  out-door 
games  are  freely  indulged  in.  The  quoits  are  made  of  rope. 
A  high  wall  built  around  three  sides  of  a  square  is  provided 
for  a  favorite  hand-ball  game.  Picnic  parties  in  summer 
are  also  frequent.  With  pianos,  games,  books,  and  papers, 
ample  provision  seemed  to  have  been  made  for  the  enter- 
tainment of  the  patients.  Sunday  services  are  regularly  held, 
and  there  is  morning  and  evening  worship  during  the  week. 

The  average  weekly  cost  of  maintenance  here  during  the 
year  ending  January  i,  1887,  is  given  as  9^-.  \\d.  per  capita. 
Patients  from  other  counties  are  charged  at  the  rate  of   i^y. 


HAN  WELL.  55 

The  visit,  as  already  indicated,  was  one  of  much  interest, 
owing  to  the  historical  prominence  of  the  place.  Consider- 
ing the  large  number  of  violent  and  dangerous  insane  here 
congregated  and  the  lack  of  space  in  some  of  the  depart- 
ments, it  was  gratifying  to  note  the  comparative  quiet  and 
order  prevailing  throughout  the  institution.  Much  of  this 
good  result  must  be  ascribed  to  the  large  percentage 
of  patients  engaged  at  industrial  employments.  In  the 
course  of  this  inspection,  permission  was  granted  to  visit 
the  wards  containing  the  most  disturbed  cases  ;  and  through- 
out an  extended  examination  no  unusual  disturbance  met 
the  eye  or  ear  in  either  wards  or  airing-courts.  Several 
patients  were  seen  in  the  refractory  wards  pacing  briskly 
to  and  fro,  also  about  the  grounds  without  ;  but  no  instance 
of  struggling  with  attendants  and  no  application  of  mechanic- 
al restraint  came  under  my  observation.  There  was  con- 
clusive evidence  that  the  methods  of  handling  the  turbulent 
elements  of  which  the  asylum  is  made  up  are  founded  upon 
humane  principles,  and  that  these  conduce  in  a  remarkable 
degree  to  good  order,  cleanliness,  and  general  contentment. 
Nevertheless,  it  appeared  to  me,  that,  from  overfulness, 
restricted  airing-courts  and  grounds,  and  the  presence  of 
numbers  too  great  for  close  individual  inspection,  the  asy- 
lum could  not  reach  those  curative  results  which  the  en- 
lightened principles  governing  it  would  seem  to  warrant. 

BAXSTEAD    LUNATIC    ASYLUM. 

This  institution,  erected  at  a  cost  of  ^^320,000,  was  opened 
in  1877.  It  is  structurally  designed  for  the  reception  of 
chronic  cases,  and,  like  the  asylums  of  Colney  Hatch  and 
Hanwell,  is  directed  by  a  Committee  of  Visitors  appointed 
by  the  justices  of  Middlesex.  It  is  located  in  the  county  of 
Surrey,  having  been  established  under  the  powers  of  the  Act 


56  ENGLAND. 

of  1853  already  referred  to  as  enabling  one  county  to  pur- 
chase lands  and  erect  and  manage  institutions  in  another 
county. 

The  Banstead  Asylum  occupies  a  bleak  and  elevated  site 
on  the  Surrey  Downs,  fourteen  miles  south  of  London.  In 
connection  with  the  institution  are  only  118  acres  of  land, 
with  less  than  100  acres  under  cultivation. 

The  asylum  is  built  of  buff  brick,  architecturally  embel- 
lished with  those  of  a  darker  color.  Its  general  plan  is  like 
that  of  Leavesden  and  Caterham,  there  being  oblong  blocks 
extending  rearward  in  two  parallel  ranges  from  either  side  of 
a  central  administration  building.  The  blocks  are  connected 
by  one-story  brick  corridors.  The  range  on  the  right  as  one 
enters  the  building  is  for  men  and  the  opposite  one  for 
women. 

Most  of  the  window-sashes  are  of  iron,  the  panes  meas- 
uring 5|- x  II  inches,  with  iron  bars  outside,  corresponding 
to  those  of  the  sash.  The  asylum  was  erected  to  accommo- 
date 1,700  patients ;  but  notwithstanding  the  small  acreage 
of  land,  additions  have  been  made  to  admit  of  300  more 
of  the  insane. 

The  resident  Medical  Superintendent  is  assisted  by  four 
medical  officers,  also  resident.  Among  the  other  salaried 
of^cials  are  a  clerk  to  the  Committee  of  Visitors  of  the  asy- 
lum, a  resident  steward  and  a  chaplain,  a  resident  engineer, 
and  a  lady  organist.  The  number  of  attendants  in  some  of 
the  wards  is  in  the  proportion  of  one  to  twenty  patients ; 
the  average  proportion  throughout  the  asylum  is  one  to  fif- 
teen patients.  There  was  an  unusual  degree  of  disturbance, 
possibly  owing  to  the  pressure  on  accommodation.  The 
small  airing-courts  were  so  full  of  patients  as  to  prevent 
healthful  recreation. 

Despite  the  fact  that  the  building  was  designed  only  for 


BANSTEAD. 


57 


the  chronic  class,  many  forms  of  acute  insanity  were  in- 
cluded in  the  cases  received.  Little  restraint  was  used 
except  for  surgical  reasons.  Locked  gloves  with  free 
thumbs  were  in  use,  and  women  were  loosely  fastened  in 
chairs  by  towels.  The  strong  dresses  worn  by  some  were 
artfully  disguised  by  fabrics  of  a  bright  color  ;  and  the  ordi- 
nary clothing,  which  seemed  comfortable,  was  also  selected 
with  a  view  to  the  avoidance  of  dull  or  sombre  hues. 

A  large  day-room  of  one  of  the  female  wards  was  over- 
crowded, the  patients  were  very  restless,  and  presented  any 
thing  but  an  agreeable  spectacle.  Some  were  crouching  or 
lying  on  the  floor  ;  others,  with  dishevelled  hair,  were  rushing 
wildly  to  and  fro. 

In  the  epileptic  ward  low  bedsteads  are  provided  with 
canvas  bottoms,  and  the  patients  are  under  night  super- 
vision. Telegraphic  communication  connects  the  office  of 
the  head  physician  with  every  department.  Electric  tell-tale 
clocks  check  the  movements  of  the  night  attendants,  and 
electric  fire-bells  are  provided  and  arranged  so  as  to  alarm, 
in  case  of  any  outbreak,  the  fire-brigade,  which  consists  of 
two  experienced  firemen  assisted  by  attendants.  The  food 
is  prepared  in  a  general  kitchen,  and  conveyed  to  the  several 
blocks.  The  water  supply  is  obtained  from  a  well  sunk  to 
a  depth  of  300  feet ;  its  capacity  being  60,000  gallons  per  day. 
The  water  is  hard,  and  the  process  of  rendering  it  suitable 
for  asylum  use  is  expensive.  The  percentage  of  inmates  use- 
fully employed  here  was  quite  small.  The  male  patients 
worked  chiefly  on  the  farm  and  in  the  garden  ;  a  few  were 
occupied  at  upholstery  and  other  trades,  and  as  helpers  in 
the  various  wards.  The  women  were  engaged  principally  at 
needlework,  ward-cleaning,  and  in  the  laundry. 

Amusements  and  means  of  entertainment  are  not  neg- 
lected,     A  library  is   provided,  out  of  which   there  were  in 


58  ENGLAND. 

circulation  among  the  patients,  at  the  time  of  my  visit, 
about  600  volumes.  Dramatic  entertainments  are  not  un- 
frequently  held,  and  it  was  stated  that  in  pleasant  weather 
there  are  occasional  picnic  excursions.  A  band,  composed 
of  asylum  attendants,  furnishes  music  for  the  weekly 
dances  and  other  amusements.  About  450  patients  attend 
divine  service  in  the  chapel. 

The  average  weekly  per-capita  cost  of  maintenance  during 
the  year  ending  January  i,  1887,  was  95-.  ^\d. 

In  this  large  and  modern  asylum  there  appeared  to  be  a 
straining  after  economy,  a  sacrifice  of  essentials,  and  a 
feeling  of  discomfort  and  confinement  among  the  inmates. 
The  writer  was  surprised  to  find  a  comparatively  new  asylum 
for  the  chronic  insane,  who  require  a  large  acreage  for  out- 
door employment,  built  upon  so  small  a  tract  of  land  ; 
and  more  surprised  to  see  such  an  institution  assuming  the 
functions  of  a  hospital  for  the  cure  of  acute  insanity. 

LEAVESDEN    METROPOLITAN    ASYLUM    FOR     THE    CHRONIC 

INSANE. 

This  asylum,  opened  in  1870,  is  situated  in  Hertfordshire, 
some  seventeen  miles  northwest  of  London,  on  a  farm  of 
eighty-four  acres.  It  was  built  to  accommodate  1,638 
patients,  and  was  subsequently  enlarged  to  receive  2,000. 
The  original  outlay  on  lands,  buildings,  fittings,  and  the 
necessary  furniture  for  its  several  departments  was  at  the 
rate  of  about  $430  per  bed.  Leavesden  is  one  of  three 
institutions  for  harmless  pauper  lunatics  of  the  metropolitan 
asylum  district.  It  is  directed  by  a  committee  of  the 
Metropolitan  Asylums  Board,  and  is  visited  by  the  Commis- 
sioners in  Lunacy.  Although  in  reality  an  asylum,  it  is,  as 
already  stated,  a  workhouse  within  the  meaning  of  the 
statute,  and  comes  immediately  under  the  supervision  of  the 


LEA  VESDEN.  59 

Local  Government  Board,  with  whom  rests  the  framing  of 
its  rules  and  regulations. 

The  number  of  inmates,  January  i,  1887,  was  885  men 
and  1,100  women,  being  an  increase  of  five  over  the  number 
here  at  the  time  of  my  visit,  when  the  staff  and  employees 
were  as  follows  :  A  medical  superintendent  with  two  assist- 
ants, chaplain,  steward,  engineer,  clerk  and  matron,  steward's 
clerk,  assistant  clerk,  assistant  matron,  head  laundress,  work 
mistress,  two  male  head  attendants,  six  first-class  married 
attendants  with  their  wives,  three  first-class  ordinary  attend- 
ants, first-class  night  attendant,  four  second-class  night  at- 
tendants, eighteen  second-class  ordinary  attendants,  two 
female  head  attendants,  nine  first-class  ordinary  female  at- 
tendants, twenty-six  second-class  ordinary  female  attend- 
ants, three  first-class  female  night  attendants,  four  second- 
class  female  night  attendants,  hail  porter,  two  first-class 
laundry  maids,  seven  second-class  laundry  maids,  cook, 
mess-woman,  baker,  assistant  baker,  mess-man,  gate  porter, 
three  store  porters,  two  scullery  men,  two  outdoor  attend- 
ants, coal  carrier,  two  laundry  men,  stoker,  earth-closet  man, 
two  gas-men,  two  tailors,  assistant  tailor,  three  shoemakers, 
two  upholsterers,  grave-digger,  cowman,  assistant  cowman, 
three  gardeners,  two  carmen,  four  farm  laborers,  foreman  of 
works,  working  engineer,  smith,  carpenter,  painter,  ordinary 
laborer,  and  plumber. 

The  asylum  is  built  of  buff  and  red  brick.  Ivy  on  the 
walls  adds  to  the  diversity  of  color  and  outline,  its  effect 
on  the  chapel  being  especially  pleasing.  The  visitor  is 
favorably  impressed  as  he  approaches  the  institution,  by  the 
grounds,  laid  out  in  lawns  and  beautified  by  shrubbery  and 
flower-beds ;  while  the  plant-houses  and  conservatories  sug- 
gest thoughts  of  summer  even  in  the  coldest  and  most 
dismal  weather.     Most  of  the  corridors  connect  with  these 


6o  ENGLAND. 

conservatories.  Each  of  the  blocks  accommodates  160 
patients,  the  ground-floor  being  for  day  use  and  the  upper 
one  for  dormitories.  They  are  warmed  and  ventilated  by 
open  fires,  supplemented  when  necessary  by  the  use  of  hot- 
water  coils. 

The  general  plan  of  the  sleeping  apartments  is  that  of  the 
associated  dormitory.  There  are  but  twenty-eight  single 
rooms  on  the  male  and  twenty-four  on  the  female  side, 
the  larger  proportion  being  in  the  infirmaries.  One  of  the 
dormitories  examined  is  divided  into  stalls  by  means  of 
wooden  partitions  about  four  feet  high.  Each  stall  contains 
two  beds,  provided  with  comfortable  mattresses  and  ample 
covering.  During  the  day  the  bedding  is  so  arranged  and 
exposed  as  to  facilitate  airing  and  inspection.  Waterproof 
sheeting,  laid  beneath  the  lower  blanket,  is  used  when  neces- 
sary. The  bedsteads  are  of  iron,  and  in  most  cases  have  can- 
vas bottoms.  The  canvas  is  broadly  hemmed,  and  is  so 
adjusted  to  the  bed-frame  as  to  permit  of  its  being  tightened 
by  screws. 

Another  dormitory  was  observed  to  contain  eighty  beds 
ranged  in  four  rows,  each  person  being  allowed  not  less  than 
400  cubic  feet  of  air-space.  Lavatories  and  closets  adjoin 
the  dormitories.  For  the  epileptics,  who  numbered  over  200 
men  and  nearly  250  women,  the  beds  are  only  six  inches 
above  the  floor.  This  class  are  under  close  night  and  day 
supervision,  which  is  checked  by  electric  tell-tale  clocks. 

A  day-room  on  the  ground-floor  contained  comfortable 
furniture,  including  easy-chairs.  There  were  also  pictures, 
baskets  of  flowers,  and  song-birds  in  attractive  cages.  Five 
open  coal  fires  in  this  large  and  cheerful  apartment  serve 
both  to  warm  the  room  and  purify  the  atmosphere. 

In  another  of  the  day-rooms  a  broad  belt  of  bright  carpet 
along  the  centre  of  the  floor,  and  rugs  in  front  of  the  fires, 


LEAVESDEN.  6 1 

gave  a  comfortable  look  to  the  apartment ;  while  pictures  on 
the  walls,  plaster  busts,  statuary,  and  other  ornaments  height- 
ened the  pleasing  effect.  In  the  windows  were  plants  and 
flowers  in  rare  profusion.  Each  of  the  day-rooms  in  the  fe- 
male ward  is  provided  with  a  piano.  On  the  men's  side  the 
day-rooms  are  likewise  comfortably  furnished  and  pleasingly 
decorated. 

The  interior  walls  here,  as  in  some  other  pauper  asylums 
in  England,  are  not  plastered,  but  are  painted  on  the  brick 
and  decorated  with  stencil-work.  The  upper  portion  of  the 
wall  is  generally  covered  with  silicate,  and  the  dado  is  painted 
a  darker  shade.  This  form  of  decoration  extends  to  the  cor- 
ridors. 

Some  of  the  windows  have  double  sashes,  with  panes  each 
i6  X  21  inches.  The  sashes  can  be  raised  and  lowered  a  few 
inches  for  ventilation.  Most  of  the  windows  have  iron 
sashes  with  panes  6|-x  i8  inches.  They  are  so  made  as  to 
be  opened  six  inches  at  the  top.  In  a  block  recently  erected, 
the  windows  have  two  sashes  provided  with  weights,  and 
there  are  outside  iron  bars. 

The  bath-room  is  lined  with  glazed  brick,  and  has  a  floor 
of  figured  tile.  Adjoining  is  a  comfortable  dressing-room 
with  an  open  fire-place.  Some  of  the  baths  are  curtained, 
affording  greater  privacy.  The  arrangements  for  bathing  are 
quite  elaborate.  The  following  is  a  list  of  the  various  baths  : 
Cold  spray,  hot  spray,  cold  wave,  hot  wave,  cold  douche,  hot 
douche,  spinal  douche,  hot  shower,  cold  shower,  hot  needle, 
cold  needle.  A  Turkish  bath  is  used  daily  by  either  male 
or  female  patients.  Dr.  Case,  the  Superintendent,  attaches 
considerable  importance  to  the  hydropathic  treatment,  par- 
ticularly for  excited  patients  and  for  those  who  do  not  sleep 
well. 

Food  is    supplied  to  the  whole  establishment  from    one 


62  ENGLAND. 

general  well-arranged  kitchen.  Cleanliness  and  order  were 
as  conspicuous  here  as  in  the  other  departments  of  the  insti- 
tution. The  walls  were  tinted,  the  deal  tables  well  scoured^ 
the  tinware  brightly  polished,  and  the  crockery  neatly  ar- 
ranged on  shelves.  Gas  and  steam  appliances  are  used  for 
cooking,  and  the  food  is  conveyed  to  the  wards  on  three- 
wheeled  trolleys.  On  the  day  of  my  visit  there  were  huge 
meat  pies  for  dinner,  the  top  of  each  being  encrusted  with 
the  number  of  the  ward  for  which  it  was  destined.  The  oc- 
cupants of  the  female  infirmary  ward  partook  of  a  wholesome 
and  well-cooked  dinner  at  a  central  table,  amply  supplied 
with  table  furniture,  including  plates,  mugs,  salt-cellars, 
pepper-boxes,  and  knives  with  a  cutting  edge  of  about  two 
inches. 

The  inmates  were  variously  employed.  In  the  laundry 
were  seen  fifty-five  women  at  work  under  nine  laundry  maids, 
and  fifteen  men  doing  the  heavier  work  under  the  super- 
vision of  two  paid  male  attendants.  The  vegetable  garden  is 
extensive.  The  supply  of  water  is  obtained  from  a  deep 
artesian  well  on  the  grounds,  that  yields  6o,®oo  gallons  per 
day.     Sewage  is  utilized  by  distribution  on  the  land. 

Among  the  means  of  restraint  are  leather  gloves.  Strong 
dresses,  laced  down  the  back,  arc  also  used,  and  occasionally 
feeble  patients  are  tied  in  chairs.  On  both  the  male  and 
female  sides  there  are  several  of  what  are  termed  "half- 
padded  "  rooms,  and  on  each  side  one  entirely  padded.  It 
was  said  that  excited  patients  were  sometimes  placed  in 
darkness  or  treated  medicinally.  The  violent  insane  are 
subject  to  night  supervision.  There  was  no  case  of  seclusion 
or  restraint  within  the  institution  at  the  time  of  my  visit. 

The  recreation  hall  for  females  is  prettily  decorated  with 
light  fresco-work.  It  contained  several  pieces  of  statuary 
and    ornamental    vases.     In    the  windows  were    flowers    in 


LEA  VESDEN.  63 

hanging-baskets  and  song-birds  in  cages.  Four  open  fires 
protected  by  screens  dispelled  the  chill  of  winter.  Among 
the  other  noticeable  articles  of  furnishing  were  a  piano,  com- 
fortable chairs,  and  cushioned  lounges.  This  spacious  apart- 
ment, fitted  up  with  a  stage  and  other  appointments,  was  used 
as  a  workroom  as  well  as  an  entertainment  hall.  The  weekly 
dances  here  were  said  to  be  attended  by  120  men  and  140 
women,  while  at  the  fortnightly  special  entertainments  the 
attendance  was  computed  at  200  men  and  240  women.  The 
annual  costume  ball,  for  which  dresses  are  made  on  the 
premises,  is  a  source  of  much  amusement ;  also  the  bur- 
lesque and  dramatic  entertainments  held  from  time  to  time. 
In  summer,  cricket  and  other  outdoor  games  are  indulged 
in.  Walking  parties  go  out  in  favorable  weather,  under  the 
charge  of  attendants.  Within  the  eleven  months  preceding 
my  visit  there  had  been  sixty-two  walking  parties  of  men, 
numbering  twenty-five  each,  with  two  attendants,  and  fifty 
parties  of  women,  numbering  fifty  each,  with  four  attend- 
ants. The  dress  of  the  patients  was  warm  and  sufificient. 
Many  of  the  women  were  seen  wearing  comfortable  scarlet 
woollen  shawls.  Some  of  the  men  were  observed  in  the  air- 
ing-court on  a  raw  wintry  morning  wearing  over  their  shoul- 
ders deep,  heavy  capes  with  thick  collars,  and  evidently 
enjoying  their  usual  exercise.  A  few,  as  they  walked  about, 
were  contentedly  smoking  their  pipes. 

The  chapel  of  the  institution  accommodates  six  liundred 
persons.  The  services  are  generally  attended  by  some  four 
hundred  patients.  The  men  and  women  sit  on  opposite 
sides  of  the  building,  and  are  about  equally  represented  at 
the  meetings.  Besides  daily  morning  and  evening  prayers, 
there  is  a  special  weekly  service  for  epileptics. 

A  library  of  entertaining  literature,  in  charge  of  the  chap- 
lain, is  used  by  both  patients  and  attendants,  and  is  main- 


64  ENGLAND. 

tained  by  a  small  annual  grant-allowed  by  the  committee  of 
management.  Some  years  the  circulation  reaches  nearly  or 
quite  10,000  volumes.  Considering  the  extensive  use  of 
the  library,  and  the  destructive  tendency  of  many  of  the 
patients,  it  seemed  remarkable  that  so  few  of  the  books 
were  injured.  Among  other  evidences  of  humane  and 
considerate  treatment,  was  the  great  attention  paid  to  the 
clothing  and  personal  cleanliness  of  the  patients. 

The  average  weekly  cost  of  maintenance  for  the  half  year 
ending  September  26,  1887,  was  Js.  ^d.  per  capita. 

CATERHAM    METROPOLITAN     ASYLUM    FOR    THE     CHRONIC 

INSANE. 

Like  Leavesden,  this  institution  is  exclusively  a  recep- 
tacle for  pauper  patients,  designed  to  relieve  ordinary  asy- 
lums of  chronic  cases,  and  to  provide  better  care  than  the 
poorhouse  affords.  It  is  managed  by  an  unpaid  committee 
of  the  Metropolitan  Asylums  Board,  and  comes  mainly 
under  the  supervision  of  the  Local  Government  Board, 
though  subject  also  to  visitation  by  the  Commissioners  in 
Lunacy. 

The  institution  is  pleasantly  situated  in  the  county  of 
Surrey,  about  fifteen  miles  south  of  London,  upon  an  ele- 
vated site  commanding  a  fine  prospect  of  the  surrounding 
country.  Connected  with  it  originally  were  but  seventy-two 
acres,  and  it  was  found  necessary  to  purchase  additional 
land  to  meet  the  wants  of  the  institution. 

The  asylum  was  opened  in  1870.  Most  of  the  buildings 
have  tile-roofs,  and  arc  plain  three-story  structures  of  buff 
and  red  brick.  The  several  sections  are  connected,  as  is  fre- 
quently the  case  in  Great  Britain,  by  inclosed  one-story  cor- 
ridors. Each  of  the  blocks  contains  about  160  patients, 
except  the  infirmary,  which  accommodates  not  more  than 


CA  TERM  AM.  65 

ninety.  In  accordance  with  modern  ideas,  additions  made 
to  the  asylum  since  it  was  first  opened  are  on  the  two-story 
plan,  the  upper  floor  being  reserved  for  dormitories  and  the 
lower  for  day  use.  The  buildings  are  constructed  with  a 
hollow  space  between  the  inner  and  outer  bricks  of  the 
walls.  The  number  of  single  rooms  is  comparativ^ely  small. 
The  windows  of  the  new  buildings  have  ordinary  sashes 
and  long  outside  bars.  The  sashes  open  a  little  way  at 
both  top  and  bottom,  and  have  panes  measuring  12  x  18 
inches.  In  the  older  buildings  the  panes  are  6\  inches 
wide.  The  Superintendent,  Dr.  Elliot,  expressed  the 
opinion  that  iron-grated  windows  are  not  necessary  for 
the  class  under  his  charge,  and  that  tile-roofs  are  not 
desirable. 

At  the  time  of  my  visit  the  patients  numbered  2,052, 
of  whom  945  were  men  and  1,107  ^vomen.  They  were 
of  the  harmless  class.  Notwithstanding  their  quiet  charac- 
ter, the  number  of  attendants  appeared  to  be  inadequate. 
Relatives,  according  to  their  means,  are  required  to  con- 
tribute towards  the  maintenance  of  patients.  There  is, 
however,  but  one  standard  of  care.  The  average  weekly 
per-capita  cost  of  maintenance  during  the  year  1887,  inclu- 
sive of  provisions,  clothing,  warming,  cleansing,  lighting, 
salaries,  furniture,  repairs,  and  medicines,  was  8.y. 

In  the  infirmary  for  women  were  thirty  patients.  The 
windows  had  shades  and  draped  curtains.  The  walls  were 
tinted  and  frescoed.  Pictures  in  considerable  variety,  bas- 
kets of  ferns,  bright  flowers  on  the  mantels,  trailing  plants, 
and  birds  in  cages  contributed  to  the  cheerfulness  of  the  sur- 
roundings. A  strip  of  carpet  extended  along  the  middle  of 
the  floor,  with  lateral  strips  between  the  beds.  The  bed- 
steads had  adjustable  canvas  stretchers,  as  at  Colney  Hatch. 
The  mattresses  were  of  horse-hair,  and  were  made  in  three 


66  ENGLAND. 

sections.  The  bedding  for  each  patient  consisted  of  linen 
sheets,  woollen  blankets,  a  coverlet,  bolster,  and  pillow. 
The  head-boards  were  covered  with  white  muslin,  on  which 
were  Scriptural  mottoes  worked  in  red  letters  by  the  pa- 
tients. Open  fires,  some  with  locked  screen-guards,  shed  a 
happy  glow  throughout  the  apartments. 

For  epileptic  patients  and  others  requiring  close  atten- 
tion the  supervision  is  continuous  through  the  twenty-four 
hours  of  each  day.  Six  attendants — three  men  and  three 
women — are  employed  nightly  for  the  oversight  of  this 
class,  which,  at  the  time  of  my  visit,  numbered  about  500 
patients.  No  mechanical  restraint  was  in  use.  It  was 
stated  that,  during  the  preceding  year,  it  had  not  been  found 
necessary  to  resort  to  seclusion,  nor  had  any  form  of  restraint 
been  applied.  In  that  time,  no  serious  accident  had  oc- 
curred to  any  of  the  asylum  patients.  There  are  two  pad- 
ded rooms,  one  on  each  side  of  the  asylum.  These  are 
rarely  brought  into  requisition.  Arm-chairs  with  wooden 
bars  in  front  are  used  for  helpless  patients.  There  are  no 
restraining  chairs  in  the  ordinary  sense  of  the  term. 

The  day  apartments  seemed  tidy  and'  well-furnished,  al- 
though not  so  elaborately  fitted  up  as  the  infirmary  ;  yet 
here  also  were  observed  flowers  and  many  objects  suggestive 
of  home  life.  Pianos  form  a  feature  of  almost  every  day- 
room.  In  the  upper  dormitories  pictures  were  noticed,  and 
flowers  in  the  curtained  windows.  Four  hundred  cubic  feet 
of  air-space  is  allotted  to  each  patient  in  the  associated 
dormitories,  and  seven  hundred  cubic  feet  to  each  in  the 
single  rooms.  Hoods  over  the  central  gas-jets  are  so  con- 
structed as  to  assist  ventilation.  There  are  ventilating  flues 
in  the  walls,  and  the  four  open  fires  in  each  ward,  or  twelve 
to  each  building,  greatly  aid  in  purifying  the  atmosphere. 
In   the  recreation   hall  hot-water  pipes  are  used.     Water  is 


CA  TERHAM.  67 

obtained  from  an  artesian  well.  In  addition  to  the  ordinary 
bathing  arrangements,  there  is  a  Turkish  bath,  and,  on  the 
men's  side,  a  swimming  bath  measuring  20  x  30  feet.  The 
food  is  prepared  in  one  general  kitchen  and  carried  to  the 
several  wards.  The  inmates  are  employed  to  the  extent 
of  their  ability — some  at  very  light  tasks. 

The  officials  wore  a  uniform  of  chocolate  color,  conspicu- 
ous on  which  were  the  brass  buttons  belonging  to  the  livery 
of  the  asylum.  The  women  attendants  wore  dresses  of  a 
dark  color.  Every  attendant  w^ore  a  leathern  belt  to  which 
was  attached  a  bundle  of  keys.  The  patients  were  vari- 
ously attired,  the  Superintendent  disapproving  of  uniform 
dresses.  The  women  wore  shawls  of  bright  colors,  in  the 
selection  of  which  the  taste  of  each  individual  was  gratified 
as  much  as  possible.  The  rule  is  here  adopted  of  substi- 
tuting, upon  admission,  clothes  furnished  by  the  institution 
for  those  belonging  to  the  patient.  If  the  dress  originally 
worn  is  claimed  by  the  committing  guardian,  it  is  returned  ; 
otherwise  it  is  given  to  the  patient  on  his  discharge,  or,  in 
the  event  of  death,  disposed  of  as  the  management  may 
direct. 

An  attractive  programme  of  amusements  is  regularly  car- 
ried out.  A  band  of  fourteen  players  drawn  from  the  staff 
of  attendants  contributes  to  the  musical  entertainment  of 
the  patients  at  stated  weekly  gatherings.  The  ^large 
amusement  hall  presented  quite  a  gala  appearance,  being 
decorated  with  flowers  and  flags  in  great  variety.  The  fit- 
tings comprised  a  stage  and  other  appurtenances,  and, 
altogether,  the  apartment  seemed  well  adapted  to  secure 
the  purposes  for  which  it  was  designed.  Theatrical  per- 
formances are  frequently  held.  Scarcely  second  in  impor- 
tance as  a  means  of  entertainment  is  the  trained  singing- 
class,  which  holds  periodical  meetings.    Patients  of  a  literary 


68  ENGLAND. 

turn  are  gratified  by  the  use  of  a  library  under  the  charge 
of  the  chaplain,  while  those  interested  in  the  current  news 
of  the  day  may  direct  their  attention  to  the  fourteen  daily 
newspapers  placed  regularly  on  the  tables  of  the  reading- 
room.  Various  outdoor  sports  are  indulged  in,  including 
cricket,  football,  and  bowling,  for  which  the  grounds  are 
specially  adapted.  Indoor  games  are  also  provided.  In 
summer  great  satisfaction  is  derived  from  walking  parties 
organized  under  the  charge  of  attendants. 

Chapel  accommodation  for  about  six  hundred  persons  is 
provided  in  a  tasteful  building  having  suitable  interior  deco- 
rations. The  chaplain  holds  daily  morning  and  evening 
services,  which  are  attended  by  between  eighty  and  one 
hundred  patients.  At  the  Sunday  morning  service  the 
attendance  usually  numbers  about  350. 

The  system  of  accounting  is  comprehensive,  showing, 
since  the  opening  of  the  institution,  the  per-capita  cost  of 
maintenance,  daily  averages,  price  of  provisions  and  other 
necessaries,  also  salaries  and  cost  of  medicines.  The  origi- 
nal outlay  on  lands,  buildings,  fittings,  and  furniture  for 
the  accommodation  of  1,672  patients,  is  stated  to  have  been 
^147,000,  or  at  the  rate  of  about  $425  per  bed. 

The  patients  admitted  here  are,  generally  speaking,  of  the 
most  enfeebled  class.  As  might  be  expected  in  an  institu- 
tion specially  designed  for  infirm  and  debilitated  chronic 
cases,  the  mortality  is  great. 

Within  and  without  the  asylum  were  evidences  of  order 
and  cleanliness,  among  which  were  the  properly  arranged 
kitchen,  the  well-aired  dormitories,  the  scoured  stone  steps, 
and  neatly  trimmed  lawns.  Although  objections  may  be 
made  to  the  unwieldy  size  of  this  institution,  and  the  small 
proportion  of  attendants  to  patients,  yet,  as  an  attempt 
to  bridge  the  chasm   between  ordinary    asylums  and  ordi- 


HA  Y  WARDS  HE  A  TH.  69 

nary  workhouses  by  providing  humane  care  for  the  chronic 
insane,  Caterham  must  be  pronounced  encouragingly  suc- 
cessful. 

SUSSEX     COUNTY    LUNATIC     ASYLUM— HAYWARDS     HEATH. 


This  asylum  opened  in  1859,  is  under  the  control  of  the 
county  justices,  who  appoint  a  Committee  of  Visitors  to 
manage  its  affairs,  and,  like  all  similar  institutions,  is  under 
the  supervision  of  the  Commissioners  in  Lunacy.  This 
county  had,  according  to  the  last  census,  a  population  of  404,- 
027.  Its  estimated  number  of  paupers  January  i,  1887,  ^^'^.s 
19,175,  of  whom  a  little  over  seven  per  cent   were  lunatics. 

The  institution  is  situated  at  Haywards  Heath,  thirty- 
seven  miles  south  of  London.  The  buildings,  of  buff  and 
red  brick,  are  approached  through  a  broad,  well-kept  road- 
way, having  on  either  side  terraced  lawns,  spacious  cricket  and 
recreation  grounds,  shrubbery,  and  flower-beds.  The  estate 
contains  between  two  and  three  hundred  acres,  comprising 
profitable  farm  and  garden  grounds. 

The  visitor  is  here  received  by  a  porter  in  blue  and  scarlet 
uniform,  who  leads  the  way  to  the  office  of  the  resident 
Superintendent.  The  broad  flight  of  stone  steps  was  cleanly 
scoured,  and  banked  on  either  side  with  a  profusion  of  potted 
flowers  and  ferns.  At  the  time  of  my  visit  there  were 
upv/ards  of  800  inmates,  the  larger  proportion  of  whom 
were  women.  Both  acute  and  chronic  cases  are  admitted. 
Nearly  all  of  the  patients  are  maintained  by  the  several 
unions  or  parishes  of  the  county  ;  a  few  arc  charged  to  out- 
lying districts,  or  are  paid  for  by  their  friends. 

The  asylum  is  mainly  of  three  stories.  The  walls  are 
constructed  with  an  air  chamber  between  the  inner  and  outer 
bricks.  In  most  cases  the  interior  is  not  plastered,  but 
painted  directly  on  the  brick.     Plastered  walls  are,  however, 


70  ENGLAND. 

preferred.  The  stairs  of  white  stone  are  of  easy  ascent. 
The  windows  have  iron  sashes,  and  are  uniform  throughout 
the  building.  The  panes  measure  5  x  lo  inches.  Two  sec- 
tions of  the  sash,  containing  two  panes  each,  open  outward. 

About  two  thirds  of  the  patients  sleep  in  associated  dor- 
mitories which  have  from  three  to  twenty-five  beds  each. 
One  of  those  on  the  women's  side  contained  nine  beds  and 
as  many  comfortable  chairs,  besides  night-chairs.  Strips  of 
carpet  were  on  the  floor,  pictures  were  hung  on  the  tinted 
walls,  and  the  windows  had  shades.  There  were  also  mir- 
rors, and  racks  for  the  towels,  and  the  dressing-table  had  a 
fancy  cover.  The  bedsteads  were  of  polished  wood.  The 
bed  furnishing  included  linen  sheets,  blankets,  a  hair  mat- 
tress, and  a  pillow  to  each  bed.  On  each  of  the  white  coun- 
terpanes was  a  fanciful  monogram  embroidered  in  bright 
colors.  The  furnishing  of  the  single  rooms  was  similar  to 
that  of  the  associated  dormitories.  Iron  bedsteads  were 
gradually  taking  the  place  of  wooden  ones.  During  the 
night  the  sleeping  apartments  are  visited  every  hour.  They 
are  heated  by  large  stoves,  and  thermometers  are  hung  on 
the  walls  to  register  the  temperature. 

A  ward  for  a  better  class  of  female  patients  was  quite  at- 
tractive. The  floors  were  carpeted,  the  windows  had  shades, 
as  well  as  curtains.  The  walls  were  papered,  and  on  them 
were  hung  numerous  pictures  ;  while  the  general  furnishing 
included  cushioned  invalid  chairs,  a  piano,  a  small  library, 
and  bagatelle  boards.  Birds  and  plants  aided  in  giving  a 
cheerful  and  attractive  aspect  to  the  room.  Outside,  on 
one  of  the  window-sills,  were  observed  several  pigeons ; 
on  another  sat  an  old,  contented  tabby — all  of  them  spe- 
cial pets  and  favorites.  The  infirmary  ward  for  women  is  a 
pleasant  apartment  containing  thirty-eight  beds. 

The  two  suicidal  and  epileptic  dormitories — one  for  men 


HAYWARDS  HEATH.  7 1 

and  the  other  for  women — contain  each  fifty  beds.  Those 
for  suicidal  cases  are  so  arranged  as  to  bring  all  the  inmates 
under  view  at  once.  Two  nurses  remain  here  overnight  and 
make  a  record  of  every  incident  that  occurs.  The  single 
rooms  for  epileptics  are  padded,  the  floor  padding  being  in 
three  sections.  Shutters  are  provided  for  darkening  the 
rooms  when  necessary.  The  visits  of  the  perambulating 
night-watch  are  checked  by  a  tell-tale  clock. 

The  dormitories  for  men  are  similar  to  those  for  women, 
except  that  the  decorations  are  not  quite  so  elaborate.  In 
one  of  those  for  epileptic  patients  were  noticed  several  deep 
bedsteads.  There  are  four  attendants  here  to  forty  patients. 
The  detached  hospital  for  men  is  under  the  care  of  a  mar- 
ried attendant  and  his  wife. 

Only  one  corridor  throughout  the  entire  building  is  warmed 
by  hot-water  pipes,  stoves  and  open  fire-places  being  the 
usual  means  of  heating.  The  lighting  is  by  gas.  Thorough 
supervision  renders  the  protection  of  gas-jets  needless. 

The  patients  of  both  sexes  are  variously  attired.  The  fe- 
male attendants  wear  brown  dresses,  black  aprons,  white  col- 
lars, and  frilled  caps  with  green  ribbon.  The  male  attend- 
ants have  dark-blue  frock-coats  with  brass  buttons,  brown 
trousers,  and  caps  with  leather  fronts.  The  wages  of  day 
attendants  begin  at  £26  a  year  and  rise  to  £\o  for  men  ; 
those  of  women  begin  at  £\6  and  rise  to  ^^30.  In  1883, 
when  the  housekeeper,  who  had  been  twenty-five  years  in 
service,  resigned  on  account  of  failing  health,  a  pension  of 
j^ioo  a  year  was  secured  for  her. 

One  general  kitchen  supplies  food  for  the  whole  estab- 
lishment. Three  meals  per  day  are  allowed  ;  viz.,  breakfast 
at  8  A.M.,  dinner  at  i  P.M.,  and  supper  at  6  P.M.,  the  sexes 
dining  in  different  rooms.  In  a  large  apartment  with  arched 
roof  and  tinted  walls  the  women  were  seen  at  dinner.    They 


72  ENGLAND. 

were  seated  at  covered  deal  tables,  at  each  end  of  which  a 
"  charge-nurse  "  presided.  Crockery,  and  blunt  knives  and 
forks  of  the  pattern  common  to  these  institutions,  were  in 
use.  Each  patient  receives  half  a  pint  of  beer  at  dinner, 
unless  it  is  Avithheld  for  special  reasons.  The  diet,  which  is 
fairly  liberal,  is  varied  daily,  and  includes  bacon,  roast  meat, 
pickled  pork,  In'sh.stew,  mutton  broth,  suet  pudding,  meat 
pudding,  bread  and  cheese,  rice,  and  fresh  fruit  in  its  season. 
Extras  are  given  to  patients  as  inducements  to  work.  These 
include  tobacco  and  snuff. 

Water  is  supplied  from  a  well  which  yields  fifty  gallons 
per  day  for  each  inmate.  Fire-hose  is  at  all  times  readily 
accessible  in  the  various  departments.  The  sewage  is  used 
to  fertilize  the  land  connected  with  the  institution.  Waste 
water  and  sewage  run  direct  to  the  sewage  farm  without 
intercepting  catch-pits  or  tanks.  At  each  angle  in  the 
sewers  there. is  an  opening  for  ventilation  and  inspection. 
A  system  of  detached  closets  has  been  introduced  here. 

What  is  designated  as  "  wet  and  dry  packing  "  is  practised 
for  medical  reasons,  and  is  the  only  form  of  mechanical 
restraint,  if  such  it  may  be  called,  in  use  in  this  asylum. 
This  treatment  the  Commissioners  in  Lunacy  regard  as 
restraint,  and  require  that  it  shall  be  so  reported.  Opinions 
differ  as  to  its  value  from  a  curative  point  of  view.  Locked 
coats,  dresses,  and  stockings  are  occasionally  used  to  prevent 
a  patient  from  scratching  or  otherwise  injuring  himself; 
but  his  arms,  hands,  and  legs  remain  free.  Seclusion  is 
sometimes  resorted  to. 

In  this  asylum  there  is  a  thorough  industrial  system, 
and  it  is  considered  of  the  utmost  importance  to  have  a 
variety  of  congenial  employments.  For  the  men  there  are 
sixteen  and  for  the  women  six  different  kinds  of  occupation. 
These  include  the  following :  Farm  and  garden  work,  shoe- 


HA  Y  WARDS  HE  A  TH. 


71 


making,  tailoring,  carpentering,  bricklaying,  painting,  up- 
holstering, mat-making,  basket-making,  laundry  work,  and 
needlework.  Patients  are  also  employed  in  the  kitchen, 
the  dining-hall,  the  store-rooms,  the  bath-rooms,  and  as 
ward  cleaners,  house  attendants,  bakers,  engineers,  etc. 
The  furniture,  baskets,  mats,  and  mattresses,  as  well  as  the 
clothes,  boots,  and  shoes  of  the  inmates  are  all  made  on 
the  premises  under  the  direction  of  skilled  artisans  who 
work  with  the  patients.  Seventy-six  per  cent  of  the 
insane  are  usefully  employed. 

The  following  is  a  complete  list  of  the  ofificers,  attendants, 
servants,  and  artisans  of  the  establishment :  Medical  super- 
intendent, senior  assistant-medical  officer,  junior  assistant- 
medical  officer,  chaplain,  clerk  to  visitors,  clerk  of  asylum, 
housekeeper,  head  female  attendant,  female  assistant  officer, 
storekeeper,  head  male  attendant,  twenty-three  male  attend- 
ants, twenty-eight  female  attendants,  five  male  night  attend- 
ants, five  female  night  attendants,  organist  and  schoolmaster, 
office  clerk,  seamstress,  head  laundry-maid,  three  laundry- 
maids,  hall  porter,  man  cook,  dairy-maid,  kitchen-maid, 
vegetable-room  maid,  three  housemaids,  two  farm  attend- 
ants, house  attendant,  bath  attendant,  engineer,  bailiff, 
gardener,  blacksmith,  front  ground  laborer,  tailor,  shoemaker, 
mat-maker,  basket-maker,  upholsterer,  baker,  butcher,  under 
garden  attendant,  carpenter,  bricklayer,  bricklayer's  laborer, 
painter  and  glazier,  stoker,  under  stoker,  cowman,  under 
cowman,  two  carters,  stockman,  and  house  carter. 

During  the  year  ending  January  i,  1887,  the  average 
weekly  per-capita  cost  of  maintenance  was  %s.  \\\d.  Pauper 
patients  from  other  counties  or  boroughs  are  charged  14^., 
and  all  private  patients,  \6s.  per  week. 

The  wards  of  this  asylum  are  well  supplied  with  books, 
papers,  and  periodicals.     Eighteen   daily  and    fifty  weekly 


74  ENGLAND. 

newspapers  and  thirty-eight  monthly  publications  are  pro- 
vided for  the  use  of  the  patients.  It  is  customary  to  expend 
about  two  hundred  dollars  yearly  in  the  purchase  of  books. 
Many  of  the  inmates  are  permitted  to  occupy  a  portion  of 
their  time  in  writing  and  in  copying  selections  from  literary 
works,  which  are  favorite  ways  of  spending  time  with  some  of 
those  who  are  best  educated.  In  winter,  the  chaplain  con- 
ducts a  school  in  the  large  dining-hall,  which  is  attended  by 
about  sixty  patients  of  each  sex.  The  three  Sunday  ser- 
vices in  the  chapel  are  attended  by  about  six  hundred  and 
fifty  of  both  sexes.  In  the  dining-hall  of  each  division  the 
chaplain  reads  prayers  daily,  at  which  services  there  are  on 
an  average  about  two  hundred  and  fifty  men  and  three  hun- 
dred women. 

The  extensive  airing-grounds  are  surrounded  by  a  haw- 
haw,  so  as  not  to  obstruct  the  view.  In  fine  weather,  parties 
of  male  and  female  patients  not  exceeding  eighty  go  out 
separately  into  the  country  for  walking  exercise,  each  party 
in  charge  of  five  or  six  attendants.  For  the  old  and  infirm, 
drives  are  regularly  arranged  ;  and  in  summer  there  are  pic- 
nic excursions  to  Brighton,  the  Crystal  Palace,  and  other 
favorite  resorts.  For  the  younger  people,  cricket  and  cro- 
quet furnish  healthful  recreation.  The  large  amusement  hall, 
in  which  weekly  dances  are  held,  is  fitted  up  with  a  stage, 
and  is  furnished  with  a  piano  and  other  appurtenances  for 
theatrical  entertainments  and  concerts.  A  fancyd-ress  ball 
is  held  during  the  winter,  which  is  largely  attended  by 
patients  in  costume.  An  average  of  three  hundred  of  both 
sexes  resort  to  the  weekly  entertainments. 

Printed  rules  of  the  institution  were  hung  in  a  con- 
spicuous place.  They  specify  the  days  on  which  visits  may 
be  made  by  outsiders,  and  the  length  of  the  visits ;  pro- 
hibit the  bringing  in  of  wine,  beer,  or  spirits,  and  direct  that 


BROOKWOOD. 


75 


nothing  shall  be  said  or  done  that  will  depress  the  patients. 
Only  under  exceptional  circumstances  is  a  patient  allowed 
to  be  visited  until  a  month  has  elapsed  from  the  date  of  his 
admission.  Friends  are  communicated  with  in  the  event  of 
serious  illness.  The  institution  was  clean  and  orderly,  and 
bore  evidence  of  enlightened  management  and  considerate 
treatment  of  the  class  under  its  care. 

BROOKWOOD   ASYLUM,    NEAR   WOKIXG,    SURREY. 

Brookwood  lunatic  asylum,  like  Haywards  Heath,  is  a 
type  of  English  county  institutions  which  differ  widely  from 
the  larger  metropolitan  receptacles  already  described.  It  is 
one  of  the  three  asylums  for  the  county  of  Surrey,  and  is 
designed  mainly  for  pauper  patients.  This  county,  which 
includes  part  of  the  metropolis  south  of  the  Thames,  ranks 
fourth  in  England  as  regards  population,  containing,  accord- 
ing to  the  last  census,  1,441,017  inhabitants.  On  the  1st  of 
January,  1887,  there  were  in  Surrey  42,021  paupers,  11.54 
per  cent  of  whom  were  lunatics. 

Like  other  county  asylums,  the  management  of  Brook- 
wood  is  in  the  hands  of  an  unpaid  Committee  of  Visitors. 
These  country  gentlemen,  most  of  whom  are  men  of  wealth 
and  influence,  serve  generally  for  a  long  term  of  years,  it 
being  customary  to  re-elect  them,  unless  they  express  a 
wish  to  no  longer  bear  the  responsibilities  of  the  position. 
The  Medical  Superintendent  controls  the  selection  and 
retention   of  his   subordinates. 

This  asylum,  situated  about  twenty-eight  miles  south- 
westerly from  London,  is  approached  through  highly  cul- 
tivated and  elaborately  ornamented  grounds.  Its  plain, 
substantial,  brick  buildings  are,  for  the  most  part,  three 
stories  high.  At  the  time  of  my  visit,  the  inmates  numbered 
421  men  and  629  women,  including  acute  and  chronic  cases. 


76  ENGLAND. 

The  interior  walls  of  the  older  portion  of  the  asylum  are 
unplastered  ;  the  newer  portion  is  plastered  on  the  brick,  a 
method  which  is  preferred  by  the  Superintendent.  Gen- 
erally, the  walls  are  tinted,  and  decorated  with  stencilled 
frieze  and  bordered  dado.  A  pleasing  effect  is  thus  pro- 
duced at  a  trifling  cost,  the  work  being  done  mostly  by  the 
patients. 

Dining-rooms,  with  scrupulously  clean  sculleries  attached, 
are  provided  for  the  several  wards.  These  accommodate 
from  thirty  to  one  hundred  patients  each.  The  knives  and 
other  table  furnishings  resemble  those  used  in  ordinary 
housekeeping.  In  a  large  dining-room  that  I  entered  there 
were  small  tables,  accommodating  eight  persons  each.  Its 
heating  arrangements,  though  in  keeping  with  modern 
ideas  of  ventilation,  were  somewhat  peculiar.  These  con- 
sisted of  two  chimney-stacks  standing  near  the  centre  of  the 
room,  and  so  placed  as  to  apportion  equally  between  them 
the  space  to  be  warmed  and  ventilated.  Each  stack  was 
built  with  two  open  fire-places  back  to  back.  The  windows 
had  heavy  draped  curtains,  and  the  appearance  of  the  room 
was  inviting.  There  are  two  general  kitchens,  one  for  the 
older  portion  of  the  asylum  and  one  for  the  new  section. 

Another  room  worthy  of  note  is  that  set  apart  for  new 
arrivals.  It  was  appropriately  furnished  with  lounges,  settees, 
and  easy-chairs,  and  made  attractive  with  pictures  and 
statuary. 

The  day-rooms  for  both  men  and  women  were  well  fur- 
nished. In  one  examined,  the  tables  had  fancy  covers  ;  on 
the  comfortable  chairs  were  tidies  made  by  the  patients;  on 
the  tables  and  in  the  windows  were  potted  plants;  and  pict- 
ures were  hung  on  the  walls,  which  were  suitably  decorated. 

In  the  dormitories,  the  bedstead.^  are  generally  of  iron, 
and   are   furnished  with   straw  and   hair  mattresses,  except 


BROOKWOOD. 


77 


where  woven-wire  bottoms  are  used,  in  which  case  the  palh- 
asse  is  dispensed  with.  The  sheeting  is  unusually  thick  and 
strong.  Narrow  borders  of  blue  or  red  stripe  distinguish  the 
bed  linen  of  the  men  from  that  belonging  to  the  women.  In 
the  older  building,  the  number  of  beds  in  the  dormitories 
ranges  from  three  to  twenty.  In  the  new  section  the  dor- 
mitories are  much  larger,  each  having  as  many  as  forty  beds. 
These  apartments  are  warmed  by  open  fires.  In  the  female 
epileptic  ward  were  ninety-eight  patients — some  violent  and 
dangerous.  All  were  under  watchful  and  systematic  super- 
vision by  night  and  day.  Here,  as  in  some  other  wards  of 
the  asylum,  was  a  piano  for  the  entertainment  of  the  pa- 
tients, a  leading  principle  in  treatment  being  to  engage  the 
mind  by  every  possible  means.  The  open  fire  was  only 
partially  screened,  yet  it  was  asserted  that  no  accident  from 
burning  had  ever  occurred  in  the  institution. 

The  new  department,  intended  to  accommodate  seventy- 
five  female  patients  in  each  of  its  four  wards,  was  erected  at 
a  cost  of  $484  per  bed.  The  open  fires  have  no  guards  of 
any  kind.  A  small  opening  may  be  made  in  the  windows 
by  means  of  a  lock  and  key.  Ventilation  is  further  effected 
by  flues  and  perforations  in  the  walls.  The  panes,  twenty 
to  a  window,  measure  9^  x  16  inches.  Thermometers  are 
hung  in  the  various  wards,  and  a  record  of  the  temper- 
ature is  made  at  different  hours  of  the  day.  The  aim  is 
to  maintain  a  uniform  temperature  of  about  sixty  degrees 
Fahrenheit.  The  single  rooms  of  the  asylum,  which  are  in 
the  proportion  of  one  room  to  nine  patients,  are  unlike  in 
coloring,  while  the  ornamental  work  is  well  adapted  to  please 
and  interest  the  patients.  The  furniture  throughout  is 
comfortable. 

The  bath-room,  which  is  of  modern  construction,  has  a 
dado  of  white  g-lazed  tile.     The  baths  are  arranged  in  stalls. 


78  ENGLAND. 

Before  a  patient  enters  the  bath  it  is  an  imperative  rule  that 
the  temperature  of  the  water,  as  well  as  of  the  atmosphere, 
must  be  ascertained  by  a  thermometer  and  recorded.  The 
temperature  of  the  water  must  not  be  less  than  eighty- 
eight  nor  more  than  ninety-eight  degrees.  In  the  event 
of  a  thermometer  being  broken,  the  orders  are  peremptory 
that  the  bath  be  suspended  until  another  is  obtained. 

About  five  hundred  yards  from  the  main  building  is  a 
small,  conveniently  planned  cottage-hospital  furnished  with 
modern  appliances.  It  accommodates  sixteen  patients,  and 
is  arranged  for  the  use  of  both  sexes. 

There  is  separate  provision  for  Church-of-England  and 
Roman  Catholic  services,  which  were  said  to  be  regularly 
and  largely  attended. 

The  average  weekly  per-capita  cost  of  maintenance  during 
the  year  ending  January  i,  1887,  was  95.  6\d. 

In  this  well-ordered  institution  there  was  a  remarkable 
absence  of  ordinary  methods  of  restraint.  It  was  claimed 
with  great  satisfaction  by  Dr.  Brushfield  that  he  had  never 
in  his  life  ordered  or  sanctioned  mechanical  restraint  of  any 
kind.  He  admitted  having  met  occasionally  with  cases 
in  which  such  treatment  might  have  been  beneficial  ;  but 
the  risk  of  abuse  was  so  great  that  he  had  been  led  to  dis- 
countenance it  entirely.  Seclusion  had  not  been  practised 
under  his  regime  since  1871.  He  believed  this  practice  led 
to  the  neglect  of  some  of  the  worst  cases  ;  he  therefore 
resolved  to  depart  from  it,  and  he  never  regretted  its  aban- 
donment. On  being  asked  what  he  meant  by  "  mechanical 
restraint,"  Dr.  Brushfield  replied  :  "  The  application  of  any 
thing  that  hinders  the  patient  in  the  free  use  of  any  part 
of  his  body."  When  he  had  a  troublesome  case  he  preferred 
to  treat  it  in  the  ward.  If  a  patient  required  seclusion,  he 
would   be  placed  in   a  room  with  two  or  three  attendants  ; 


BROOKWOOD. 


79 


but  in  no  case  was  a  door  locked.  In  fact,  the  attendant 
who  ventured  to  lock  a  door  under  such  circumstances 
would  be  at  once  discharged.  Formerly  there  was  no 
padded  room  ;  now  there  are  two,  one  on  each  side  of 
the  asylum.  They  are  rarely  used,  being  required  only 
for  very  violent  and  epileptic  cases.  Special  restraining 
contrivances,  the  Doctor  thinks,  only  increase  excite- 
ment. He  had  frequently  found  it  advantageous  to 
remove  a  patient  from  one  ward  to  another.  He  did  not 
classify  to  any  extent,  and  had  no  refractory  ward.  Classi- 
fication, in  his  opinion,  might  easily  be  carried  too  far. 
Seclusion  he  defined  ordinarily  to  mean  "  keeping  a  patient 
in  a  room  with  locked  doors."  In  that  sense  he  did  not 
permit  seclusion,  regarding  it  as  a  device  for  enabling  and 
encouraging  subordinate  ofificers  and  attendants  to  shirk 
their  duty  or  abuse  the  patients.  Each  patient  is  weighed 
on  admission  and  at  different  times  during  his  stay  in  the 
asylum. 

The  male  attendants  are  attired  in  blue  suits.  The  female 
nurses  wear  dark-green  dresses,  white  aprons,  and  caps 
trimmed  with  ribbon.  The  attendants  throughout  the  insti- 
tution are  in  the  proportion  of  one  to  ten  patients.  The 
wages  of  a  first-class  male  attendant  commence  at  £^2,  in- 
creasing ^i  yearly  to  a  maximum  of  £4.0  per  annum,  with 
board,  lodging,  washing,  and  each  year  two  suits  of  uniform. 
Second-class  male  attendants  begin  at  £2?>,  increasing  in  the 
same  way  to  ^^32  per  annum,  with  board,  etc.,  as  stated. 
First-class  female  attendants  commence  with  ^20  per  an- 
num, rising  to  £26  ;  and  second-class  at  £16,  rising  to  £20, 
with  board  and  minor  perquisites.  Since  my  visit  there  have 
been  some  slight  changes  in  the  salaries  and  wages.  The 
doors  of  the  attendants'  rooms  have  large  glass  panes  and 
curtains,  the  latter  being  drawn  aside  during  the  day  to  admit 


80  ENGLAND. 

of  ready  inspection.  The  reports  of  events  during  the  night 
are  minute  in  detail.  The  day  reports,  which  must  be 
submitted  before  9  P.M.,  set  forth  the  extent  and  kind  of 
the  employments  of  the  day — if  unemployed,  they  state 
the  cause — ;  also  the  number  taking  recreation,  the 
number  in  bed  and  their  condition,  the  number  wearing 
locked  boots,  strong  or  special  dresses,  acts  of  violence, 
attempts  at  suicide,  accidents  if  any,  and  even  the  minutest 
incident. 

Connected  with  the  institution  are  224  acres  of  farm  and 
garden  land.  The  cultivation  of  this  affords  healthful  em- 
ployment for  the  patients.  As  many  as  eighteen  acres  are 
tilled  with  the  spade.  The  gardener  is  a  skilled  nursery- 
man and  florist.  The  farm  lands  are  superintended  by  a 
resident  bailiff.  In  the  farm  cottages,  of  which  there 
are  five,  reside  quiet  patients  who  work  in  the  fields.  The 
farm,  garden,  and  dairy  are  highly  profitable.  The  barren 
heath  which  surrounded  the  institution  in  its  early  days  has 
been  converted  into  a  garden  of  fertility.  The  first  step 
taken  was  to  lay  out  a  nursery  for  the  propagation  of 
plants.  This  eventually  repaid  all  labor  expended  upon 
it,  by  yielding  sufficient  shrubbery  for  the  ornamentation 
of  the  grounds.  Subsequently  it  not  only  supplied  the 
needs  of  the  asylum,  but  proved  a  source  of  revenue  from 
the  sale  of  surplus  plants.  A  large  conservatory  upon 
which  much  care  is  bestowed  adds  to  the  attractiveness 
of  the  institution.  This  furnishes  throughout  the  winter 
a  plentiful  supply  of  choice  and  fragrant  flowers  for  the 
various  rooms  and  wards  of  the  asylum.  Dr.  Brushfield 
considers  suitable  occupation  one  of  the  most  important 
factors  in  treatment,  and  remarks  :  "  So  long  as  the  number 
of  the  employed  is  double  that  of  the  unemployed,  I  am 
satisfied." 


BROOKWOOD.  8 1 

About  120  patients  were  daily  at  work  under  the  direc- 
tion of  the  farm  bailiff  and  the  gardener,  and  were  about 
equally  divided  between  the  two.  Other  male  patients 
were  occupied  as  follows :  Helpers  in  wards,  32  ;  in 
kitchen  and  vegetable  room,  25  ;  in  domestic  ofifices,  21  ; 
as  bricklayer,  i  ;  bakers,  4  ;  upholsterers  and  polishers,  7  ; 
basket-makers,  4 ;  bookbinders,  4 ;  mat-makers,  3 ;  shoe- 
makers, 8  ;  tailor,  i  ;  painters,  7  ;  plumber,  i  ;  assisting 
engineer,  5  ;  joiners,  3  ;  and  in  the  laundry,  8.  Paid  artisans 
not  only  oversee,  but  work  with  the  patients  in  all  the 
mechanical  departments.  On  the  female  side  upwards  of 
400  were  daily  employed.  The  following  list  shows  the 
occupations :  Helpers  in  wards,  144  ;  sewing  and  quilting, 
106;  mending,  42  ;  laundry  work,  37  ;  making  men's  cloth- 
ing, 36;  in  kitchen  and  dining-hall,  26;  knitting  and  netting, 
14 ;  boot  and  shoe  binding,  4 ;  assisting  housemaid,  4. 
Owing  to  an  increasing  amount  of  laundry  work,  steam 
machinery  had  been  introduced,  although  Dr.  Brushfield 
favors  washing  by  hand  for  the  robust  and  excitable,  and 
ironing  for  the  depressed.  Since  my  visit,  a  separate  foul- 
linen  wash-house  has  been  erected  here,  with  suitable  dis- 
infecting and  rinsing  tanks.  The  payment  of  money  to 
patients  as  a  reward  for  the  labor  they  perform  is  regarded 
with  favor,  and  has  been  attended  here,  as  elsewhere,  with 
good  results. 

Though  a  strong  advocate  of  employment  as  a  legitimate 
means  of  cure.  Dr.  Brushfield  did  not  push  his  theories  in 
this  direction  so  far,  to  use  his  own  language,  as  to  make  the 
asylum  simply  "a  well-regulated  workhouse."  He  regards 
every  asylum  superintendent  as  "  primarily  a  medical  ofHcer 
of  a  hospital  for  the  treatment  of  insanity,  and  one  who 
looks  to  the  treatment  of  the  patient  as  his  first  and  most 
important    duty."      Founded    upon    these    solid    principles, 


82  ENGLAND. 

Brookwood  has  justly  attained  a  high  reputation  for  thor- 
ough as  well  as  economical  administration. 

While  the  importance  of  useful  labor  is  properly  recog- 
nized, recreation  and  amusement  are  by  no  means  neglected. 
The  large  recreation  hall,  accommodating  eight  hundred,  is 
ornamented  with  statuary,  and  amply  supplied  with  the 
usual  appointments  of  a  theatre.  A  number  of  patients 
were  seen  at  work  adjusting  stage  apparatus  for  a  forthcom- 
ing entertainment.  Fancy-dress  balls  are  held  every  year. 
These  were  spoken  of  as  a  source  of  much  amusement. 
They  are  generally  attended  by  about  five  hundred  patients 
and  a  limited  number  of  the  general  public.  For  these 
interesting  occasions  ladies  of  the  district  supply  dress 
material,  which  is  made  up  by  the  patients.  At  the  weekly 
musical  meetings  two  bands  perform  under  the  direction  of 
attendants.  Programmes  for  these  gatherings  are  printed 
on  the  premises.  Each  ward  has  at  least  one  bagatelle 
board.  There  is  a  well-stocked  library  to  which  the  patients 
have  access,  while  the  supply  of  serial  and  comic  literature 
is  abundant. 

The  deportment  of  the  patients  was  orderly,  and  the  gen- 
eral aspect  of  contentment  was  quite  marked.  No  one  was 
permitted  to  crouch  on  the  floor  or  to  remain  in  any  other 
unbecoming  position,  nor  was  there  any  evidence  of  that 
want  of  self-respect  which  is  allowed  to  remain  uncorrected 
in  some  institutions.  In  the  discharge  of  the  duties  devolv- 
ing upon  them,  the  attendants  appeared  equal  to  their  as- 
sumed responsibilities.  Without  architectural  display  or 
other  extravagance,  comfortable  and  proper  provision  for 
the  insane  seemed  to  be  here  attained  ;  and  appropriate 
as  were  the  fittings  and  furnishings  of  this  institution,  that 
which  impressed  me  most  favorably  was  the  humane  spirit 
pervading  its  entire  administration. 


WAKEFIELD. 


83 


THE  WEST  RIDING  PAUPER  LUNATIC  ASYLUM — WAKEFIELD. 

Yorkshire,  comprising  in  its  three  divisions,  or  ridings,  an 
area  of  6,067  square  miles,  is  the  largest  county  in  Great 
Britain.  In  population  it  ranks  next  to  Middlesex.  It  had, 
according  to  the  last  census,  2,894,527  inhabitants.  The 
estimated  number  of  paupers  in  Yorkshire  on  the  ist  of 
January,  1887,  was  75,915.  Of  these,  7.43  per  cent  were 
lunatics.  The  population  of  the  West  Riding,  according  to 
the  last  census,  was  2,197,811.  The  estimated  number  of 
paupers  in  this  division  on  January  i,  1887,  was  53,803,  of 
whom  4,247  were  lunatics.  The  pressure  for  asylum  accom- 
modation has  been  so  great  in  the  West  Riding  that,  since 
my  visit,  the  justices  have  put  in  course  of  erection  a  new 
asylum  to  accommodate  1,310  patients.  It  is  situated  in  the 
township  of  Menstone,  and  has  325  acres  of  land,  which  were 
purchased  at  a  cost  of  £20,'j20,  or  upwards  of  8300  per  acre. 
The  buildings  are  estimated  to  cost  ^188,992,  or  about  $700 
per  bed.  When  this  institution  is  completed  there  will  be 
three  large  asylums  for  the  West  Riding.  The  other  two  di- 
visions of  the  county  have  one  asylum  each. 

The  asylum  at  Wakefield,  a  three-story  building,  accom- 
modating about  1,400  patients,  cannot  be  regarded  as  a 
model  structure.  It  is  built  of  brick,  and  wears  the  sombre 
hue  of  age,  having  been  opened  in  1818.  Lawns,  flower 
borders,  grass-plots,  and  carefully  tilled  vegetable  gardens, 
surround  the  institution.  The  estate  contains  120  acres  of 
land. 

The  Superintendent,  who  occupies  a  separate  residence, 
had,  at  the  time  of  my  visit,  five  medical  assistants.  There 
were  two  chief  attendants  on  the  men's  side,  with  fift}'-four 
subordinates  for  day  and  five  for  night  duty.  On  the 
women's  side  there  were  two  head  nurses,  with  fifty-seven 
assistants   by   day   and    five    for   night    duty.     The   general 


84  ENGLAND. 

average  of  attendants  to  patients  was  one  to  ten  ;  in  the  re- 
fractory wards,  one  to  five ;  and  in  the  suicidal  wards,  one  to 
eight.  The  salaries  of  male  attendants  ranged  from  ^^30  to 
^50  a  year,  in  addition  to  uniforms.  This  compensation, 
whicJi  is  here  considered  liberal,  secures  long  and  reliable 
service.  It  was  ofificially  stated  in  1886  that  forty  male  and 
twenty-one  female  attendants  had  been  in  the  service  of  the 
institution  over  five  years,  and  that,  during  the  previous  year, 
only  one  attendant  had  been  discharged  ;  while  one,  during 
the  same  period,  was  retired  on  a  pension. 

As  we  entered  the  day-room  of  the  convalescent  ward  for 
women,  a  patient  was  playing  a  lively  air  on  the  piano.  The 
furnishing  included  large  tables,  arm-chairs,  a  sewing-ma- 
chine, book-cases,  pictures,  and  a  variety  of  minor  ornaments. 
Two  open  fires,  with  rails  three  feet  high  in  front,  warmed  and 
ventilated  the  apartment.  There  was  considerable  variety 
in  the  dresses  of  the  women.  Ribbon  bands,  generally 
green,  were  worn  around  the  neck  and  waist.  The  attend- 
ants were  neatly  attired  in  dresses  of  blue  serge,  with  white 
caps  and  linen  collars;  but  there  was  a  jarring  jingle  of  keys 
suspended  from  their  leathern  belts. 

The  dormitory  on  an  upper  floor  had  bay-window  projec- 
tions, within  which  were  wash-stands  and  toilet  ware.  Sev- 
eral good-sized  mirrors  were  hung  on  the  walls.  The  wooden 
bedsteads  are  constructed  with  an  inner  framework,  on  which 
a  canvas  bottom  is  stretched.  Each  bed  is  supplied  with  a 
hair  mattress  and  an  abundance  of  comfortable  bedding. 
The  sheets  of  this  department  are  distinguished  by  a  red 
border.  By  means  of  partitions  four  feet  high  the  central 
space  is  divided  into  stalls  ten  feet  wide,  in  which  the  beds 
are  placed.  Each  stall  has  a  strip  of  carpet  on  the  floor  and 
a  cushioned  seat.  The  nurses  occupy  one  end  of  the  dormi- 
tory,  from  which   the  entire  apartment  can  be  supervised. 


WAKEFIELD.  85 

Several  patients  were  seen  wearing  dresses  buttoned  be- 
hind, and  occasionally  there  was  one  wearing  locked  boots. 
In  the  epileptic  ward  the  patients  are  by  night  constantly 
under  the  supervision  of  a  regular  watch,  whose  attend- 
ance is  checked  by  tell-tale  clocks.  Records  of  tempera- 
ture are  made  by  attendants  three  times  during  the  night. 
On  the  walls  of  the  suicidal  ward  were  noticed  many  colored 
prints,  and  in  front  of  the  open  fires  screens  are  used  during 
the  night. 

The  refractory  ward  on  the  women's  side  contained  arm- 
chairs, wooden  settees,  upholstered  lounges,  also  rugs  and 
strips  of  carpet.  There  were  high  railings  before  the  fire. 
The  pictures  were  hung  within  easy  reach.  Single  rooms 
here  have  wooden  bedsteads  with  canvas  bottoms,  a  rug  by 
the  side  of  each  bed,  and  sliding  shutters  to  the  windows. 
The  floors  were  cleanly  scoured.  To  this,  as  to  the  other 
wards,  a  small  scullery,  closet,  and  bath-room  are  attached. 
The  occupants  of  this  refractory  ward  numbered  forty. 
Twenty  slept  in  single  rooms,  eleven  in  one  dormitory,  and 
nine  in  another.  The  corridors  have  tinted  walls  decorated 
with  pictures. 

The  general  bath-room  measures  20  x  50  feet,  and  contains 
ten  baths  ranged  on  either  side  of  a  central  passage.  Muslin 
curtains  adjusted  on  a  framework  of  gas-pipe  posts  and  rods 
are  provided,  shutting  in  three  sides  of  the  bath.  The  heat- 
ing is  effected  by  means  of  hot  air.  The  windows  are  of 
frosted  glass.  The  taps  of  hot,  cold,  and  waste  water,  are 
under  the  sole  control  of  the  attendant,  and  every  thing  is 
kept  attractively  clean.  In  an  adjoining  apartment  are  the 
usual  appointments  of  a  Turkish  bath.  The  baths  include 
vapor,  sitz,  overhead,  needle,  shower,  and  the  ordinary 
douche. 

A  building   of   recent   construction,   for  convalescents,  is 


86  ENGLAND. 

two  stories  high,  and  accommodates  one  hundred  and  twenty- 
male  patients.  Here,  in  the  first  room  entered,  were  seen 
rows  of  pigeon-holes  for  boots  and  shoes.  Adjoining  this  is 
a  lavatory  furnished  with  the  usual  appliances,  including 
roller-towels  and  looking-glasses.  The  rooms  were  warmed 
by  open  fires  in  front  of  which  were  screens  2^  feet  high. 
Comfortable  couches,  cushioned  seats,  rugs,  and  pictures 
were  included  in  the  furnishing.  Five  attendants  were  on 
duty  here  by  day,  but  there  was  no  special  night  watch. 

The  day-rooms  on  the  men's  side  contain  pianos,  billiard 
and  bagatelle  tables,  arm-chairs,  and  pictures  hung  on  the 
papered  walls.  These  rooms  are  heated  by  open  fires.  In 
connection  with  the  men's  infirmary  is  a  small  glass-covered 
conservatory  containing  a  choice  collection  of  exotic  and 
other  plants  and  a  small  aquarium.  The  conservatory  is 
furnished  with  comfortable  seats. 

In  two  houses  detached  from  the  main  building  upwards 
of  fifty  chronic  and  harmless  insane  are  kept.  Want  of 
accommodation  is  felt  here  as  in  almost  every  other  asylum 
in  England.  There  arc,  in  all,  one  hundred  single  rooms 
in  the  institution  and  on  three  floors  there  are  thirty 
strong  rooms  with  flush-panelled  doors  opening  outward,  so 
that  they  cannot  be  blocked  by  the  patients.  The  walls  of 
these  rooms  are  covered  with  silicate,  and  the  window-panes 
measure  6x  10  inches.  A  room  on  the  female  side  is  padded 
in  sections.  It  has  a  bed  on  the  floor,  and  a  double-sash 
small-pancd  window  protected  by  a  padded  shutter  adjusted 
by  weights.  A  dormitory  on  the  first  floor  of  the  asylum 
is  allotted  to  the  fire  brigade,  which  is  composed  of  attend- 
ants and  patients,  who  arc  called  out  every  month,  without 
previous  notice,  for  training  and  inspection.  Fire  extinguish- 
ers were  observed  about  the  building. 

The  women  take  their  meals  in  their  wards,  sometimes  as 


WAKEFIELD.  8/ 

many  as  one  hundred  dining  together.  The  general  dining- 
room  for  men  is  wide,  and  measures  one  hundred  feet  in 
length.  It  has  high  windows,  and  is  fitted  up  with  a  stage 
at  one  end  and  a  gallery  at  the  other, — the  apartment  serving 
the  double  purpose  of  dining  and  recreation  hall.  The 
tables  at  the  time  of  my  inspection  were  arranged  for  dinner, 
with  linen  table-cloths,  crockery,  and  ordinary  knives  and 
forks.  Twenty-two  sat  at  each  table.  Before  commencing 
the  meal,  all  stood  and  sang  grace.  The  dinner  consisted  of 
boiled  beef  and  pork,  potatoes,  carrots,  parsnips,  and  bread, 
with  beer  brewed  on  the  premises.  As  many  as  three 
hundred  and  sixty  dine  together  in  this  hall.  After  dinner 
they  remain  chatting  and  singing  until  it  is  time  to  resume 
work.  Meals  are  supplied  from  the  general  kitchen,  in 
which  every  thing  appeared  scrupulously  clean. 

Over  one  thousand  of  the  inmates  are  engaged  in  some 
kind  of  work.  About  two  hundred  and  fifty  are  employed 
in  farm,  garden,  and  other  outdoor  work.  A  peculiar  feature 
of  this  institution  is  its  large  department  for  weaving,  this 
being  an  important  industry  in  the  district,  and  one  with 
which  many  of  the  inmates  are  familiar.  There  were  twenty- 
nine  patients  employed  in  the  making  of  sheeting  and  other 
fabrics.  Fifteen  looms,  and  a  large  number  of  bobbin 
wheels  turned  by  hand,  were  ranged  on  two  sides  of  a  long 
building.  This  department  is  under  the  control  of  an 
artisan  attendant.  In  the  carpenter's  shop,  six  is  about 
the  usual  number  employed.  Tailoring  is  an  important 
branch  of  the  industrial  section,  eighteen  patients  being  em- 
ployed at  this  trade.  Seven  of  the  tailors  had  served  their 
apprenticeship  in  the  establishment,  and  the  instructor  in- 
formed me  that,  in  his  time,  seventeen  had  learned  the  trade 
after  becoming  inmates.  The  tailor's  workroom  is  well 
adapted  to  its  purpose.     It  is  warmed  by  an  open  fire  and 


88  ENGLAND. 

is  well  lighted.  It  contained  three  sewing-machines.  The 
foreman,  who  had  been  here  more  than  twenty  years,  said 
he  had  never  known  a  patient  to  hurt  himself  or  others 
with  the  tools  used.  Making,  as  well  as  repairing,  is  done 
here.  The  workers  were,  at  the  time  of  my  visit,  busy  on 
a  batch  of  strong  linen  rugs,  machine-stitched  in  the 
form  of  small  squares,  each  rug  measuring  2  x  2|-  yards. 
These  were  intended  for  night  covering  for  patients  of  de- 
structive tendencies.  Cloth  of  a  dark  color  is  used  for  the 
patients'  jackets,  and  that  of  a  light  color  for  their  trousers. 
The  dark-blue  uniforms  worn  by  the  attendants  are  made 
here.  In  the  shoe-shop,  sixteen  men  were  at  work  making 
and  repairing  shoes.  Various  machines  are  used  for  cutting 
leather,  riveting,  and  for  other  work.  The  attendant,  who 
had  been  here  many  years,  stated  that  no  casualty  had  oc- 
curred within  his  knowledge  from  misuse  of  tools.  In  the 
tinware-room  two  patients  were  employed,  and  there  was 
the  same  number  in  the  plumber's  room.  Picking  horse- 
hair and  making  mattresses  gave  employment  to  thirty-five 
patients  in  another  department.  A  machine  for  renovating 
the  hair  of  mattresses  had  been  in  use  for  a  number  of 
years,  and  was  highly  approved  by  the  management.  In 
the  book-bindery,  in  which  were  all  the  requisite  appli- 
ances, three  patients  were  at  work,  while  a  like  number 
found  employment  in  the  blacksmith's  shop. 

The  laundry  is  a  separate  department  and  is  presided  over 
by  a  head  attendant.  It  is  extensive,  well-arranged,  and 
furnished  throughout  with  the  latest  machinery.  Here  were 
enerafjed  one  hundred  women  under  five  attendants,  with  a 
few  laundry  maids.  Six  male  patients  in  an  apartment 
partitioned  off  from  the  female  quarters  were  engaged  under 
an  employee  in  doing  the  heavier  work.  In  washing  the 
licfhter  articles  a  number  of  hand  machines  were  used. 


WAKEFIELD.  89 

Of  the  1,405  patients  here,  there  were  only  181  males  and 
190  females  unemployed.  The  men  were  not  at  work  for 
the  following  reasons  :  Sixty-two  were  too  sick  or  too  feeble, 
38  were  aged  and  infirm,  11  were  too  low-spirited,  31  too 
much  excited,  33  had  too  little  mind,  6  were  able  but  un- 
willing. The  women  were  not  employed  for  the  following 
reasons  :  Twenty-five  were  too  sick  or  too  feeble,  37  were 
aged  and  infirm,  3  were  too  low-spirited,  62  too  much  ex- 
cited, 48  had  too  little  mind,    15   were  able  but  unwilling. 

The  gas  for  the  establishment  is  made  on  the  premises. 
Water  from  the  town  is  used,  and  there  is  also  an  artesian 
well  on  the  grounds.  Attempts  to  utilize  the  sewage  on 
the  farm  had  been  unsatisfactory,  and  it  was  afterwards  dis- 
charged into  the  public  sewerage  system. 

The  old  adage,  "  A  place  for  every  thing  and  every  thing 
in  its  place,"  applies  to  the  minutest  details  of  this  estab- 
lishment. An  illustration  of  this  was  seen  in  the  yard, 
where  are  a  few  small  out-houses,  or  stores,  with  an  aper- 
ture in  the  door  of  each,  through  which  waste  articles  may 
be  passed.  The  locked  doors  are  labelled  ;  as,  for  example, 
"broken  glass,"  "old  tin,"  "old  lead."  The  contents  of 
these  receptacles  are  regularly  removed. 

It  was  said  that,  in  favorable  weather,  some  six  hun- 
dred patients  were  permitted  to  enjoy  exercise  about  and 
beyond  the  grounds.  About  five  hundred  attend  worship 
every  Sunday,  the  Church-of-England  service  being  the  form 
used.  Nearly  seven  hundred,  with  about  equal  numbers  of 
men  and  women,  were  recorded  as  attending  the  weekly 
entertainments. 

Very  little  seclusion  is  here  practised,  and  it  was  said  that 
mechanical  restraint  is  never  resorted  to  except  for  surgical 
reasons.  This  is  corroborated  by  the  Commissioners  in 
Lunacy,  who,  in  a   late   report   on    the  institution,  remark 


90  ENGLAND. 

that  during  the  year  "  the  use  of  mechanical  restraint  or  se- 
clusion has  in  no  instance  been  found  necessary."  On  the 
death  of  a  patient  z.  post-mortem  examination  is  made,  unless, 
on  admission,  the  friends  had  filed  an  objection  with  the 
management.  The  average  weekly  per-capita  cost  of  main- 
tenance here  for  the  year  ending  January  i,  1887,  is  given 
as  Zs.  ^%d. 

THE   SOUTH   YORKSHIRE    PAUPER   LUNATIC    ASYLUM — 
WADSLEY. 

This  asylum,  three  miles  from  Sheffield,  is  a  modern  insti- 
tution compared  with  that  of  Wakefield  for  the  same  division 
of  Yorkshire,  having  been  opened  in  1872.  It  was  built  for 
the  pauper  insane,  but  at  the  time  of  my  visit  it  contained  a 
few  paying  patients  who  had  been  temporarily  received. 
The  total  number  of  inmates  was  1,160,  of  whom  660  were 
women.  The  buildings  are  situated  on  a  rising  slope  over- 
looking an  extensive  fertile  valley.  They  are  of  brick,  with 
stone  caps  and  sills  to  the  doors  and  windows,  and  the  roofs 
are  of  slate.  After  passing  the  porter's  lodge  near  the  iron 
entrance  gate,  the  visitor  proceeds  a  quarter  of  a  mile  along 
a  gravelled  roadway  to  the  asylum  buildings.  A  substantial 
stone  church  is  an  attractive  feature  of  the  place.  The 
broad  green  lawns  are  beautified  with  laurel  and  other  ever- 
greens, which  are  disposed  so  as  not  to  obstruct  pleasing 
views  of  the  surrounding  country. 

In  the  main  entrance  hall  there  was  a  profusion  of  plants 
in  full  bloom,  that  had  been  brought  from  the  conservatory 
and  here  tastefully  arranged.  The  greenhouse  is  large,  and 
supplies  an  abundance  of  bedding  plants  for  the  grounds. 

One  of  the  day-rooms  on  the  women's  side,  which  may 
serve  for  a  general  illustration,  presented  a  cheerful  appear- 
ance.    It  had  a  large  bay-window  and  two  open  fires  with 


WADSLE  V.  91 

rugs  in  front.  The  floor  was  carpeted  and  the  walls  were 
papered.  Statuary,  pictures,  hanging-baskets,  wicker  and 
other  kinds  of  easy  chairs  contributed  to  the  general  cozi- 
ness. 

In  the  men's  infirmary  the  windows  have  double  wooden 
sashes  with  panes  about  5x15  inches.  On  the  floor  were 
broad  strips  of  oil-cloth  with  bright  borders.  Easy  seats 
were  provided,  and  a  few  pictures  were  hung  on  the  walls. 
Adjoining  this  ward  is  a  small  conservatory,  in  which  were 
seats  for  patients. 

The  refractory  wards,  like  the  others,  are  suitably  fur- 
nished, and  brightened  with  pictures  and  other  decorations. 
In  connection  with  each  of  these  wards  are  one  or  two  secure 
single  rooms.  There  were  no  screens  in  front  of  the  open 
fires.  There  are  two  padded  rooms  on  the  men's  and  two 
on  the  women's  side.  These  have  double  doors,  and  the 
mattresses  are  placed  on  the  floor.  In  the  institution  at  the 
time  of  my  visit  there  were  about  eighty  male  and  an 
equal  number  of  female  patients  of  the  epileptic  class. 
They  were  under  the  special  supervision  of  attendants  by 
night  as  well  as  by  day. 

In  addition  to  a  system  of  heating  by  means  of  hot-water 
pipes,  fire-places  or  open  grates  are  in  every  ward.  Locked 
fire-screens  are  used  only  in  the  wards  for  suicidal  and  epileptic 
patients.  There  are  a  few  movable  but  no  fixed  guards  to 
the  windows.  In  one  corridor  was  observed  an  arrangement 
to  promote  the  health  and  comfort  of  the  patients,  which  is 
worthy  of  general  adoption.  This  consisted  of  a  range  of 
cupboards  with  shelves  made  of  slats,  under  which  are  pipes 
heated  by  steam.  Here  are  placed  the  damp  garments  of 
the  patients  after  they  return  from  outdoor  work.  A  large 
lavatory  which  adjoins  this  corridor,  is  provided  with  roller- 
towels.      These    are    hung  above    coils    of   steam  pipes  to 


92  ENGLAND. 

facilitate  drying.  Satisfactory  arrangements  for  bathing  are 
connected  with  each  ward. 

The  men  dine  in  a  spacious  hall;  the  women  in  their 
wards.  On  the  day  of  my  visit  the  dinner  consisted  of  roast 
pork  and  rice,  which  seemed  to  be  well  cooked  and  was 
apparently  relished.  Table-cloths,  crockery,  and  ordinary 
knives  and  forks  were  in  use.  The  kitchen  was  clean  and 
attractive.  Twelve  patients  were  here  engaged  paring  pota- 
toes. In  the  bakery,  aerated  bread  is  made.  The  dough  is 
kneaded  by  steam  power.  Adjoining  the  bakery  is  the 
brewery  containing  three  large  vats  and  all  the  requisites 
for  brewing.  Here  is  made  the  beer  which  is  served  out  to 
the  patients  at  the  daily  rate  of  one  pint  to  workers  and  half 
a  pint  to  non-workers.  Since  my  visit,  the  dietary  has  been 
changed  so  that  only  patients  working  in  the  hay-field  and 
the  attendants  composing  the  band  are  furnished  with  beer. 
Water  is  substituted  for  it  at  the  patients'  mid-day  meal. 
The  attendants  generally  are  allowed  \s.  6d.  per  week  to 
men  and  i^.  per  week  to  women  instead  of  this  beverage. 

The  laundry  is  a  separate  and  quite  extensive  establish- 
ment connected  with  the  main  building  by  a  corridor.  The 
clothes  are  successively  passed  into  washing,  wringing,  iron- 
ing, and  sorting  rooms.  In  order  to  furnish  desirable  em- 
ployment for  a  certain  class  of  the  insane,  the  washing  is 
done  by  hand.  Water  is  obtained  from  a  well,  from  which 
it  is  pumped  into  a  reservoir  that  has  a  capacity  of  800,000 
gallons.  The  asylum  is  also  connected  with  the  Sheffield 
water  system. 

Employed  in  various  ways  were  240  men  and  360  women. 
In  the  tailor's  shop  were  nine  patients,  including  one  epilep- 
tic, under  a  paid  worker  who  had  been  for  a  number  of 
years  in  the  place  he  then  occupied.  He  said  that  he  had 
never  experienced  any  difficulty  in  controlling  the  patients. 


IVADSLEY.  93 

Three  sewing-machines  were  here  in  use.  In  the  shoe- 
maker's shop,  which  is  fitted  up  with  the  usual  appHances, 
seven  men  were  at  work.  In  the  carpenter's  shop  were 
two,  and  in  the  painter's  shop  were  four  patients — all  work- 
ing industriously.  Ten  men  were  employed  in  the  upholstery 
department.  Dr.  Mitchell,  the  resident  Superintendent, 
said  that  within  his  knowledge  no  patient  in  the  mechanical 
department  had  ever  inflicted  injury  upon  himself  or  others. 

About  one  hundred  of  the  men  in  favorable  weather  work 
out-of-doors  upon  the  farm  and  grounds,  which  contain  in  all 
193  acres.  About  twenty-five  acres  are  irrigated  by  sewage 
distributed  from  several  large  tanks.  Cottages  are  provided 
for  the  bailiff  and  cowman.  With  the  latter  are  lodged  ten 
patients  who  take  their  breakfast  and  tea  with  him,  but  dine 
with  the  patients  in  the  general  dining-room.  A  portion  of 
the  asylum  is  two  stories  high,  the  upper  one  being  used  for 
dormitories  and  the  lower  one  for  day-rooms. 

Separate  hospital  accommodation  is  provided  for  men  and 
women.  Post-mortem  examinations  are  made  of  the  bodies 
of  about  three  fourths  of  the  patients  who  die,  permission 
having  first  been  obtained  from  friends  of  the  deceased. 

The  average  of  attendants  to  patients  throughout  the  asy- 
lum is  as  one  to  ten.  The  female  attendants  wore  black 
dresses,  with  white  caps  and  aprons.  A  uniform  dress  gave  a 
pauper  appearance  to  the  women  patients,  who  were,  for  the 
most  part,  attired  in  blue  print  gowns  and  check  aprons. 
The  male  patients  were  dressed  in  accordance  with  their 
several  employments. 

From  the  terraces  of  the  airing-courts  an  extended  view 
is  obtained  beyond  the  sunken  walls.  The  number  restricted 
to  a  limited  area  for  outdoor  exercise  was  large.  Comforta- 
ble scarlet  hoods  are  worn  by  female  patients  when  they  are 
■out-of-doors  in  cold  weather. 


94  ENGLAND. 

The  capacious  dining-hall,  with  its  three  large  bay-windows, 
is  used  for  purposes  of  entertainment.  It  is  provided  with  a 
stage,  gallery,  and  accommodation  for  a  band  which  is  made 
up  of  sixteen  attendants.  On  the  stage  was  a  good  piano. 
This  hall  also  serves  as  a  reading-room,  having  chairs,  side- 
tables,  and  books.  A  library,  to  which  the  patients  have 
access,  is  under  the  direction  of  the  chaplain.  The  chapel, 
where  services  are  regularly  held,  accommodates  about  four 
hundred  patients. 

A  few  unteachable  idiots  are  among  the  inmates  of  this 
institution.  Here,  as  in  many  other  places,  the  Superintend- 
ent complained  that  the  large  number  of  chronic  cases  hin- 
dered his  asylum  from  properly  exercising  its  curative  func- 
tions. 

Since  my  visit  to  this  asylum  it  has  been  enlarged,  so  that 
at  the  date  of  January  i,  1887,  it  contained  1,543  patients. 
Forty-seven  of  these  were  private  patients,  for  whom  a 
weekly  charge  of  from  14.?.  to  20.v.  was  made.  The  average 
weekly  cost  of  maintenance  during  the  year  ending  January 
I,  1887,  was  8.y.  \d.  per  capita. 

LANCASTER   COUNTY   ASYLUM — PRESTWICH. 

This  is  one  of  four  pauper  asylums  that  meet  the  wants 
of  a  count}^  having  the  largest  population  of  any  in  Great 
Britain,  including,  as  it  does,  large  centres  of  life  and  indus- 
try like  Liverpool  and  Manchester.  According  to  the  last 
census,  Lancaster  contained  a  population  of  3,485,611.  On 
the  1st  of  January,  1887,  it  was  estimated  to  have  83,321 
paupers,  of  whom  10.23  per  cent  were  lunatics.  The  as\-- 
lum  at  Prestwich  is  about  fifteen  minutes'  ride  by  rail  in  a 
northeasterly  direction  from  the  great  cotton  manufacturing 
,  city  of  Manchester.  The  buildings,  which  are  of  brick  with 
slate-roofs,  are  for  the   most  part  three  stories  high.     They 


K  ng-hal:_,    PRESTVv  -Ct^ 


PRESTWICH. 


95 


are  surrounded  by  ornamental  grounds.  Just  inside  the 
entrance  gate  is  a  neatly  constructed  porter's  lodge,  which 
is  a  distinctive  feature  of  English  asylums.  Indeed,  the  rules 
respecting  the  porter  and  his  duties  are,  in  many  places,  as 
precisely  and  clearly  laid  down  as  are  those  for  the  guidance 
of  the  medical  staff.  On  approaching  the  asylum  buildings, 
one  is  pleased  to  see  that  the  windows  are  free  from  bars. 
The  patients,  dressed  in  drab  moleskin,  the  ordinary  attire 
of  workingmen  in  this  part  of  the  country,  were  at  work 
about  the  grounds  with  wheelbarrows,  rollers,  and  garden 
tools. 

At  the  time  of  my  visit,  the  resident  Superintendent,  Dr. 
Ley,  was  assisted  by  four  medical  officers.  There  were  529 
male  and  674  female  patients  ;  and  the  number  of  attendants 
to  patients  was  one  to  nine.  An  annexe  intended  to  ac- 
commodate about  800  patients  was  in  process  of  construc- 
tion. This  has  since  been  completed  and  occupied,  and  the 
medical  staff  of  the  asylum  and  the  number  of  attendants 
have  been  increased.  The  inmates,  January  i,  1887,  num- 
bered 998  men  and  1,161  women,  making  a  total  of  2,159 
patients.  A  very  few  of  these  are  private  patients,  who  are 
received  at  a  charge  of  from  15^-.  to  2\s.  per  week. 

In  an  inspection  of  the  interior  of  this  institution  one  is 
gratified  from  the  outset.  The  various  wards  are  simply  but 
neatly  decorated  and  appropriately  furnished.  In  the  in- 
firmary wards  for  female  patients  were  seen  numerous 
busts  and  pictures,  lambrequins  and  light  draped  curtains 
at  the  windows,  exotic  and  other  plants  about  the  rooms, 
and  tidies  upon  the  chairs. 

The  convalescent  wards  on  the  women's  side  are  fitted  up 
similar  to  the  infirmary  wards.  The  comfortable  furniture 
and  numerous  articles  for  use  and  ornament  recall  the  home- 
like apartments  of  Brookwood. 


96  ENGLAND. 

In  the  ward  for  very  troublesome  or  refractory  female 
patients  were  curtains,  lambrequins,  upholstered  furniture, 
statuarj"",  pictures,  busts,  and  decorations  similar  to  those  in 
the  other  wards.  Notwithstanding  the  class  of  patients,  the 
open  fires  here  are  only  partially  screened.  The  windows 
are  large  and  without  bars.  In  connection  with  this  ward 
is  a  spacious  open  court,  in  which  is  a  small  conservatory. 

The  furnishing  and  general  arrangements  of  the  apart- 
ments for  both  sexes  are  very  nearly  alike,  except  that  the 
interior  decorations  on  the  women's  side  are  more  elaborate 
than  those  on  the  men's  side.  A  large  proportion  of  the 
beds  have  woven-wire  bottoms,  horse-hair  mattresses,  scarlet 
counterpanes,  strong  white  linen  sheets,  and  two  pillows  to 
each.  For  the  single  rooms  there  are  double  doors,  the 
inner  one  having  an  aperture  in  the  panel  to  facilitate  super- 
vision. Open  fires  throughout,  even  in  the  wards  for  sui- 
cidal patients,  are  only  partially  protected  by  a  guard.  This 
method  of  heating  is  supplemented  by  a  system  of  hot-water 
pipes.  The  older  windows  have  iron  sashes  with  panes  5  x 
14  inches  ;  but  wooden  sashes  with  panes  8x12  inches  are 
gradually  superseding  them.  The  hand-rails  in  the  stair- 
ways are  sunk  in  the  wall,  thus  fulfilling  the  ordinary  pur- 
pose of  support  without  projecting. 

In  a  new  dormitory,  constructed  on  modern  and  improved 
principles,  the  bedsteads  are  of  iron  and  have  woven-wire 
bottoms,  upon  which  are  laid  block-mattresses  made  of  silk- 
waste.  Beside  each  bed  was  a  thick  red  rug.  In  the  sleeping 
apartments  for  the  epileptics,  a  low  form  of  bedstead  is  used. 
Near  each  bed  was  a  stand  fitted  with  shelves.  A  variety  of 
simple  yet  tasteful  articles  ornamented  the  rooms. 

There  are  one  or  two  padded  rooms,  which,  it  was  said, 
are  rarely  used.  Seclusion  is  sometimes  resorted  to.  In  the 
event  of  the  failure  of  moral  suasion,  a  refractory  patient  is 


PRESTWICH. 


97 


placed  in  charge  of  a  staff  of  attendants  large  enough  to 
overcome  any  resistance. 

The  dining-halls  of  this  institution  are  spacious  and  are 
elaborately  furnished.  That  for  the  women  accommodates 
upwards  of  three  hundred.  At  one  end  is  a  stage,  indicat- 
ing that  the  place  is  also  available  for  entertainments.  At 
the  opposite  extremity  is  a  gallery  for  the  orchestra.  The 
dining-tables  are  regularly  arranged  in  the  body  and  along 
the  sides  of  the  hall.  Each  table  has  its  spotless  linen  cover, 
and  chairs  for  ten.  The  crockery  used  is  of  the  ordinary 
table  pattern.  Through  the  high  arched  roof  of  glass  there 
is  admitted  an  abundance  of  light.  The  gas-jets  have  bright 
colored  shades.  Arranged  about  the  hall  are  numerous  life- 
sized  busts  and  figures  and  a  great  variety  of  luxuriant 
plants  and  flowers,  among  which  are  canary-birds  in  cages. 
A  general  survey  of  the  apartment  gratifies  the  eye  by  a  di- 
versity of  pleasing,  yet  not  costly,  objects ;  while  the  orderly 
arrangement  and  the  scrupulous  cleanliness  manifested  not 
only  here,  but  throughout  the  institution,  give  evidence  of 
excellent  administration.  It  is  worthy  of  special  note  that 
the  ornamentation  of  this  beautiful  hall,  as  well  as  of  other 
parts  of  the  establishment,  was  done  by  the  patients  who 
worked  with  and  were  directed  by  a  few  skilled  artisans. 
The  dining-hall  for  men  is  somewhat  smaller  than  that  for 
women,  but  is  scarcely  less  elaborate  in  its  furnishing  and 
decorations,  both  apartments  being  well  adapted  to  interest 
and  gratify  the  patients.  In  the  infirmary  dining-room,  the 
walls  are  papered.  Small  tables  and  chairs  are  used  here, 
as  in  the  hall  just  described.  As  would  be  expected,  the 
diet  in  this  department  is  of  a  better  quality.  ]3eer  brewed 
on  the  premises  is  allowed  to  all  the  inmates.  Non-workers 
receive  half  a  pint  per  day,  while  workers  have  double  that 
quantity. 


98  ENGLAND. 

This  institution,  like  most  other  Enghsh  asylums,  labors 
under  the  great  disadvantage  of  having  a  small  estate.  Ad- 
ditions have  been  made  within  a  few  years  at  a  cost  of  up- 
wards of  $i,ooo  per  acre  ;  but  even  now  there  are  only  150 
acres  connected  with  the  asylum,  fifty-nine  of  which  are 
covered  by  buildings,  or  used  as  airing-courts  or  grounds  for 
exercise.  Twelve  acres  of  the  land  are  leased  at  a  high 
rental.  At  the  time  of  my  visit,  about  250  men  worked 
either  on  the  land,  in  the  workshops,  or  in  the  ofifices,  in 
addition  to  113  ward  cleaners.  Twenty-nine  insane  men 
reside  at  the  farm-house  and  six  in  a  detached  cottage.  Of 
the  women,  upwards  of  200  were  engaged  in  attending  to 
the  wards;  38  in  the  laundry  ;  52  in  the  kitchen  and  offices; 
and  225  at  various  kinds  of  needlework.  All  the  tailoring, 
dressmaking,  shoemaking,  and  repairing  for  the  establish- 
ment is  done  on  the  premises. 

In  suitable  weather  parties  of  male  and  female  patients  in 
charge  of  attendants  take  walks  beyond  the  asylum  grounds. 
Besides  the  weekly  dancing  parties,  there  arc,  in  winter, 
theatrical  and  other  entertainments. 

A  chapel  in  which  Church-of-England  service  is  held  every 
Sunday  is  conveniently  situated  on  the  grounds.  Mass  is 
celebrated  weekly  within  the  institution  for  Roman  Catho- 
lics, and  a  Rabbi  conducts  religious  services  at  stated  times 
for  the  Jewish  patients. 

Of  those  admitted  to  this  asylum  Dr.  Ley  has  taken  much 
pains  to  tabulate,  from  time  to  time,  the  causes  of  insanity, 
having  gathered  his  information  from  examinations  of  his- 
tories of  the  patients,  and  from  inquiry  of  and  correspond- 
ence with  the  friends  and  relatives.  The  facts  which  he 
has  thus  collected  and  the  conclusions  he  has  drawn  there- 
from are  very  suggestive.  He  says  of  his  investigations 
made  during  the  year  1885  : 


PRESTWICH. 


99 


"  In  about  27  per  cent  no  cause  could  be  assigned,  as  nothing 
reliable  could  be  ascertained  in  regard  to  the  antecedents  of  those 
patients.  Classifying  the  assigned  exciting  causes  as  mental  and 
physical,  the  mental  causes  constitute  23  per  cent,  and  the 
physical  about  55  per  cent.  Prominent  among  the  former  are 
worry,  anxiety,  and  domestic  and  pecuniary  troubles.  Of  the 
physical,  intemperance  in  drink  is  preeminent,  reaching  about  25 
per  cent  of  all  causes,  and  next  to  this  comes  ill-health,  epilepsy, 
and  disorders  peculiar  to  the  female  sex.  It  will,  however,  be 
observed  that  a  large  proportion  of  cases  in  which  special  exciting 
causes  are  assigned,  have  in  addition  strong  hereditary  predispo- 
sition to  the  disease.  At  least  28  per  cent  inherited  a  weakened 
nervous  organization,  too  feeble  to  resist  ordinary  exposure,  and 
prone  to  become  deranged  by  various  disturbing  influences, 
social,  religious,  or  commercial.  The  troubles  and  worries  of  life 
are  rarely  powerful  enough  of  themselves  to  upset  a  healthy 
brain,  and  drink  and  other  kindred  excesses  are  far  more  likely 
to  derange  the  bodily  health  of  the  individual  and  carry  him  to 
the  general  hospital  than  bring  him  to  the  asylum.  The  experience 
of  this  and  of  other  asylums  points  to  the  fact  that  the  special 
causes  usually  enumerated  as  factors  in  the  production  of  insan- 
ity are,  in  the  majority  of  instances,  secondary  to  the  great 
fundamental  cause — constitutional  predisposition." 

The  Lunacy  Commissioners  in  one  of  their  reports  have 
paid  a  just  tribute  of  praise  to  Dr.  Ley  for  his  admirable 
management  of  this  institution.  As  has  been  pointed  out  by 
them,  it  would  be  difficult  to  find  any  asylum  wards  which 
equal  those  of  Prestwich  in  comfort  or  are  more  tastefully 
decorated.  The  objects  of  art  used  for  ornamentation  come 
within  the  reach  of  patients  known  to  be  wantonly  de- 
structive, yet  their  beauty  seems  to  be  a  sufficient  safe- 
guard, and  very  rarely  is  any  mischief  done  to  them.  The 
Commissioners  say : 

"  It  is  satisfactory  to  add  that  all  these  great  improvements  are 
executed  solely  by  patients'  labor,  superintended  by  skilled 
artisan  attendants,  whilst  all  the  furniture,  fern  cases,  etc.,  are 
obtained    by   the   same   means,   as   well   as   the  busts   and   pot- 


lOO  ENGLAND. 

tery  which  adorn  the  walls.  We  cannot  too  highly  express  our 
gratification  at  the  appearance  of  the  wards,  and  we  must  add 
that  we  are  astonished  to  find  that  all  this  is  done  at  a  per-capita 
cost  of  no  more  than  8^.  2d.  per  week.  We  doubt  if  any  other 
asylum  in  the  country  has  any  thing  approaching  to  the  comfort 
and  even  luxury  provided  here  at  such  a  rate." 

LANCASTER   COUNTY   ASYLUM — WHITTINGHAM. 

The  asylum  at  Whittingham,  opened  in  1873,  was  planned 
to  accommodate  1,100  patients.  It  is  situated  in  the  country 
about  six  miles  north  of  Preston.  The  buildings  are  of  red 
brick,  and  are  one,  two,  and  three  stories  in  height.  They 
cover  a  considerable  extent  of  ground,  and  are  connected 
by  one-story  corridors.  The  original  estate  contained  only 
155  acres  of  inferior  land,  which  was  bought  for  about  $276 
per  acre.  Small  additions  have  since  been  made  by  pur- 
chase, and  some  land  has  been  leased  for  the  use  of  the 
asylum.  The  building  accommodation  proving  insufficient 
to  meet  the  growing  demands  upon  the  institution,  it  has 
been  found  necessary  to  erect  an  annexe  for  the  separate 
treatment  of  chronic  cases.  At  the  time  of  my  visit  the 
inmates  numbered  1,260,  of  whom  550  were  men  and  710 
were  women.  The  annexe  has  since  been  completed,  and  at 
the  date  of  January  i,  1887,  there  were  1,679  patients. 

The  dormitories  are  on  the  associate  plan,  some  of  them 
containing  as  many  as  forty  beds.  For  greater  privacy, 
the  beds,  which  occupy  the  central  space  in  the  room,  are 
separated  from  one  another  by  partitions  four-and-a-half  feet 
high,  so  arranged  as  to  form  compartments  or  stalls  opening 
towards  the  windows.  Wooden  bedsteads  arc  used.  A 
bright  rug  was  spread  in  front  of  each  bed.  The  bare  ap- 
pearance of  the  walls  was  somewhat  relieved  by  painting, 
and  decorations  about  the  windows.  The  lower  sections  of 
the  windows  had  screens  on  the  inside.  Thermometers 
were  hung'  in  each  ward. 


WHITTINGHAM.  lOI 

The  day-rooms  were  plainly  furnished.  The  walls  were 
plastered  and  painted,  and  brightened  by  colored  stencilling. 
They  were  adorned  with  illuminated  mottoes,  pictures,  and 
plaster  casts.  Near  the  windows  were  flowers  in  hanging- 
baskets.  The  window-sashes  were  hung  with  weights  and 
cords.  On  the  floors  of  the  long  connecting  corridors  were 
laid  strips  of  carpet.  Though  not  generally  approved  in 
English  asylums,  metal  ware  instead  of  crockery  was  used 
in  the  lavatories.  The  infirmary  was  comfortably  and  ap- 
propriately furnished.  Low  beds  are  provided  for  epilep- 
tics.    They  have  a  special  night  watch. 

There  are  two  padded  rooms — one  on  the  men's  and  one 
on  the  women's  side.  In  reply  to  an  inquiry  respecting 
restraint,  it  was  said  :  ''  We  have  no  restraint.  Occasion- 
ally we  put  on  gloves,  but  not  very  often.  We  use  no  cribs, 
nor  have  we  ever  used  them."  Dresses  buttoned  behind 
are  worn  in  certain  cases.  Sometimes  two  or  three  attend- 
ants hold  a  violent  patient  rather  than  seclude  him.  Wet 
packing  is  also  occasionally  resorted  to.  The  patients  were 
well  clothed,  and  there  was  some  variety  in  the  style  of 
their  dresses. 

There  is  a  very  large  general  dining-room  here,  which 
serves  also  as  an  amusement  hall.  The  food  appeared  to 
be  suf^cient  in  quantity,  and  fair  in  quality.  Crockery  and 
blunt-pointed  steel  knives  were  used  at  table  in  the  ordinary 
dining-room,  but  not  in  the  refractory  wards. 

The  airing-courts,  to  which  a  large  number  of  patients 
were  restricted,  are  fairly  extensive.  Selected  parties  of 
patients  in  charge  of  attendants  are  allowed  to  go  into  the 
country  for  exercise  in  suitable  weather.  There  arc  long 
walks  laid  out  within  the  boundaries  of  the  asylum  estate, 
besides  ample  tennis  and  cricket  grounds.  Athletic  sports 
and  dances  on  the   green  in  summer,  and  theatrical  enter- 


I02  ENGLAND. 

tainments  and  concerts  during  the  winter  months  are  in- 
cluded in  the  routine  of  exercises.  Dr.  Wallis  strongly 
advocates  the  providing  of  amusements  for  the  insane.  He 
says  : 

*'  They  lighten  the  tedium  of  the  winter  months,  and  make  a 
pleasant  break  in  the  monotony  of  asylum  life  (a  thing  most 
desirable  in  itself  for  both  patients  and  ofhcials),  and  are  only 
second,  in  my  opinion,  to  good  food,  rest,  and  occupation,  in 
furthering  the  recovery  of  the  curable  cases,  while  they  reconcile, 
to  some  degree,  many  hopeless  and  weary  patients  to  their  lot, 
and  cause  them  for  a  time  to  forget  their  troubles.  The  prospect 
of  attending  these  entertainments  acts,  too,  as  a  most  potent  stimu- 
lus to  good  behavior  in  many  of  our  turbulent  and  troublesome 
patients  ;  nothing  is  more  likely  to  bring  out  their  powers  of  self- 
control  than  the  dread  of  being  prohibited  from  attending  the 
next  theatrical  performance  or  tea-party.  The  reconstruction 
and  enlargement  of  our  stage,  recently  carried  out,  has  enabled 
us  to  undertake  successfully  more  ambitious  plays  than  here- 
tofore." 

On  an  average,  about  53  per  cent  of  the  patients  here 
are  variously  employed.  In  order  to  give  occupation  to  a 
certain  class  of  excitable  patients,  much  of  the  washing  is 
done  by  hand,  a  large  number  of  ordinary  wash-tubs  being 
used  for  this  purpose.  A  considerable  force  of  men  in 
favorable  weather  work  upon  the  land,  about  one  hundred 
and  fifty  acres  of  which  are  devoted  to  farm  and  garden 
purposes.  The  crops  raised  are  oats,  hay,  and  a  variety  of 
vegetables,  including  turnips  and  potatoes.  The  average 
weekly  cost  of  maintenance  during  the  year  ending  January 
I,  1887,  was  js.  \o\d.  per  capita. 

The  method  of  heating  was  in  a  transition  state.  The 
authorities  were  trying  the  experiment  of  substituting  hot- 
water  pipes  for  open  fires.  The  effect  was  quite  marked. 
Under  the  new  arrangement  an  expression  of  gloom  was 
depicted  on   the  faces  of  the  patients  as  they  stood  in  their 


BIRMINGHAM.  IO3 

comparatively  cheerless  apartments  gazing  forlornly  upon 
the  black  registers  which  had  taken  the  place  of  the  bright 
open  fires.  It  was  manifest  that  the  depression  was  felt 
even  by  the  attendants.  On  the  other  hand,  the  rooms 
where  the  open  fires  were  still  in  use,  presented  a  pleasing 
contrast,  the  glow  of  the  warm  fire  seeming  to  impart 
cheerfulness  to  both  patients  and  attendants.  This  was 
the  only  place  in  England  where  I  saw  any  attempt  to 
economize  by  the  substitution  of  a  hot-water  system  of 
heating  for  open  fires,  and  the  experiment  was,  to  say  the 
least,  discouraging. 

About  five  hundred  patients  attend  divine  service  on  Sun- 
day, separate  places  being  provided  for  Church-of-England 
and  Roman  Catholic  worship. 

Here,  as  in  some  other  of  the  huge  English  asylums,  the 
disadvantage  of  bringing  together  large  numbers  of  the 
insane  was  strikingly  apparent. 

BIRMINGHAM   BOROUGH   ASYLUMS. 

The  Winson  Green  Asylum  stands  on  a  somewhat  elevated 
site  in  the  suburbs  of  Birmingham.  The  buildings  are  of 
brick  and  are  mostly  three  stories  high.  The  inclosed 
grounds,  containing  some  forty  acres,  are  well  kept.  The 
institution  is  designed  chiefly  for  pauper  patients,  and  is 
managed  by  a  Committee  of  Visitors  appointed  by  the 
Council '  of  Birmingham,  of  which  committee  the  Mayor  is 
a  member.  As  in  many  other  English  asylums,  an  excessive 
number  of  chronic  patients  have  been  found  to  interfere 
with    the    curative    functions    of   this    asylum,   and,  at    the 

'  By  the  Act  of  1853  and  that  of  1S55,  the  Councils  of  boroughs  having  a 
Quarter  Sessions,  recorder,  and  clerk  of  the  peace,  by  giving  notice  to  one  of  her 
Majesty's  principal  Secretaries  of  State  of  their  intention  so  to  do,  thereby 
assume  all  the  duties  and  powers  conferred  by  statute  upon  the  justices  of 
boroughs  in  respect  to  the  erection  and  management  of  borough  asylums. 


I04  ENGLAND. 

time  of  my  visit,  a  new  one,  designed  to  accommodate  some 
eight  hundred  chronic  and  imbecile  cases,  was  in  process  of 
erection.  This  is  situated  at  Rubery  Hill,  eight  miles  out  of 
Birmingham.  Owing  to  limited  accommodations,  it  had 
been  found  necessary  to  contract  with  other  institutions 
for  the  reception  of  patients.  The  provision  made  here 
for  the  pauper  insane  is  not  inferior  to  that  for  indigent 
patients  of  the  non-pauper  class. 

The  several  wards  were  well  furnished.  In  the  sleep- 
ing apartments,  there  was  noticed  in  front  of  each  wooden 
bedstead  a  strip  of  carpet.  The  furnishing  of  each  bed  com- 
prised two  mattresses  and  a  fair  supply  of  bed-clothes.  The 
interior  brick  walls,  although  for  the  most  part  unplastered, 
are  pleasingly  tinted  and  stencilled.  In  the  sitting-rooms 
the  walls  were  papered  and  adorned  with  pictures.  The 
windows  were  provided  with  lambrequins,  and  the  floors 
covered  with  linoleum.  In  some  of  the  apartments  were 
carpets  and  cushioned  lounges.  Epileptic  patients  are  under 
special  supervision.  There  are  two  padded  rooms  in  the 
institution — one  for  each  sex.  In  the  refractory  wards,  the 
floors  are  of  tile.  The  windows  have  iron  sashes,  with 
panes  measuring  5x8  inches.  It  was  said  that  mechanical 
restraint  was  resorted  to  only  for  surgical  reasons  or  for  pa- 
tients inclined  to  commit  suicide,  and  that  occasionally  it 
was  found  necessary  to  have  recourse  to  seclusion. 

Those  able  to  work  arc  provided  with  employment  to  the 
extent  of  their  ability.  Six  patients  were  engaged  at  shoe- 
making.  One  of  the  industries  carried  on  here  is  that  of 
match-box  making.  A  considerable  number  were  engaged 
in  keeping  the  grounds  in  order. 

The  attendants  were  uniformly  dressed,  the  women  wear- 
ing dark  gowns,  and  white  caps  trimmed  with  green  ribbon. 
The  dress  of  the  patients  seemed  fairly  comfortable,  though 


BIRMINGHAM.  IO5 

some  of  the  men  appeared  too  thinly  clad  considering  the 
severity  of  the  weather.  On  the  men's  side,  are  three  con- 
fined airing-courts  used  respectively  by  infirmary  patients, 
idiotic  children,  and  the  refractory.  There  is  also  one  gen- 
eral airing-court. 

The  Medical  Superintendent,  whose  experience  extended 
over  a  period  of  nearly  forty  years,  spoke  of  the  great 
changes  that  had  taken  place  in  the  treatment  of  the  insane 
within  the  memory  of  living  men.  He  mentioned  having 
seen  as  many  as  fourteen  men  in  a  single  room  chained  to 
a  wall.  Even  the  fire-irons  were  in  his  earlier  days  chained 
to  prevent  personal  injury.  Then,  the  bare  suggestion  of 
permitting  an  insane  man  to  use  a  knife  and  fork  at  meals, 
would  have  filled  the  mind  of  an  asylum  superintendent 
with  consternation.  Spoons  even  were  forbidden,  but  after 
a  time  were  sanctioned  ;  and  opinion  gradually  changed 
until  at  length  the  use  of  the  knife  and  fork  was  allowed. 
"  I  had  long  desired,"  he  said,  "  to  banish  from  my  practice 
slavish  adherence  to  mechanical  restraint  in  every  variety 
of  form  which  then  obtained  ;  but  I  was'  strongly  opposed 
by  the  managing  Committee.  Indeed,  my  repeated  appeals 
in  this  direction  got  me  into  rather  bad  favor  with  them. 
It  so  happened,  that,  during  one  of  their  meetings,  a  patient 
was  reported  to  be  in  a  condition  of  great  excitement.  He 
had  fortified  himself  so  strongly  in  his  room  that  no 
attendant  dared  enter.  I  was  jocosely  asked  b\-  the  Chair- 
man of  the  Committee  to  put  this  patient  under  one  of  my 
non-restraint  experiments.  The  challenge  was  accepted.  I 
went  to  the  ward,  found  the  patient  strongly  barricaded,  and 
threatening  death  to  all  comers.  In  spite  of  the  entreaties 
of  friends  and  attendants,  I  made  my  way  alone  into  the 
room  beside  him.  Knowing  his  great  fondness  for  tobacco, 
and   pretending  not  to  notice  his  disturbed  condition,  I  pro- 


I06  ENGLAND. 

posed  a  smoke,  at  the  same  time  offering  him  some  tobacco. 
The  ruse  was  entirely  successful.  The  patient  instantly 
calmed,  and  permitted  himself  to  be  disarmed  and  conveyed 
to  another  ward.  From  that  date,  the  managers  of  the 
institution  ceased  to  scoff  at  the  practicability  of  restraint 
by  other  means  than  that  of  irons." 

In  this  old  asylum,  unrelieved  by  many  modern  improve- 
ments, there  appeared  to  be  little  worthy  of  imitation. 
The  yards,  or  airing-courts,  were  small  and  prison-like; 
the  amount  of  land  and  other  requirements  insufficient 
for  the  wants  of  a  large  and  populous  district  like  that  of 
Birmingham  ;  and  the  attendance  quite  inadequate  to  give 
effect  to  the  advanced  theories  of  the  Superintendent. 

Since  my  visit,  drill,  calisthenic  exercises,  and  singing 
classes  have  been  introduced  here.  Their  introduction  was 
the  result  of  the  favorable  report  of  a  special  committee  who 
visited  the  Richmond  Asylum,  Dublin,  where  these  exer- 
cises form  a  part  of  the  educational  system  introduced  by  the 
late  Dr.  Lalor.  Other  changes  have  taken  place  and  im- 
provements have  been  made  by  the  new  Superintendent, 
which  have  raised  this  institution  to  a  higher  standard. 
The  asylum  at  Rubery  Hill  has  been  opened,  and,  January 
I,  1887,  it  contained  574  patients.  This  has  relieved  the 
overcrowding  at  Winson  Green,  which,  on  January  i,  1887, 
had  575  patients.  The  per-capita  average  weekly  cost  of 
maintenance  during  the  year  ending  January  1,  1887,  at 
Winson  Green  was  8.S.  \\\d. ;  at  Rubery  Hill,  8.y.  %d . 

THE   friends'    retreat— YORK. 

Projected  in  the  spring  of  1792  and  opened  in  1796,  the 
York  Retreat  is  memorable  as  the  place  where  the  non- 
restraint  principle  was  first  adopted  in  Great  ]3ritain — where 
William  Tuke,  on  behalf  of  the  Society  of  Friends,  coura- 


THE  FRIENDS'  RETREAT.  lO/ 

geously  renounced,  as  did  Pinel  in  Paris,  the  use  of  chains 
and  manacles  in  the  treatment  of  the  insane. 

This  asylum  is  about  a  mile  from  the  city  of  York. 
An  ivy-covered  wall  incloses  the  extensive  and  somewhat 
elevated  grounds,  which  are  artistically  laid  out  and  carefully 
kept.  The  Retreat,  a  private  institution,  or  "  registered  hos- 
pital," is  still  directed  by  those  who  are,  for  the  most  part, 
members  of  the  Society  of  Friends.  It  has  a  yearly  income 
of  about  $75,000.  The  buildings  are  old-fashioned,  but 
wear  an  aspect  of  unpretentious  comfort.  In  the  oldest 
part,  some  of  the  arrangements  scarcely  meet  all  modern 
requirements.  "  The  Lodge,"  a  building  recently  erected 
for  men,  is  constructed  on  modern  principles,  and  fur- 
nished in  a  style  approaching  luxury.  Eight  women  oc- 
cupy a  sumptuously  furnished  detached  residence  called 
"  Bellevue  House."  There  is  also  a  neat  villa  residence  for 
the  reception  of  a  few  female  patients. 

In  the  wards  of  the  male  and  female  divisions  the  beds  and 
bedding  appeared  to  be  clean  and  comfortable,  and  the 
apartments  were  warm  and  well-ventilated.  The  corridors, 
with  tinted  walls  and  bright  embellishments,  were  quite 
pleasing.  The  windows  in  the  oldest  portion  have  iron 
sashes,  with  panes  6^  x  J^  inches  ;  in  the  newer  portions,  the 
panes  are  larger,  and  the  sashes  are  adjusted  by  weights  and 
cords.    The  patients  have  their  meals  in  their  several  wards. 

A  large  sitting-room,  in  which  were  noticed  a  fernery  and 
a  variety  of  other  attractions,  is  used  on  Sunday  evenings 
for  religious  services,  at  which  are  present  those  of  widely 
different  beliefs.  Patients  to  whom  it  is  proper  to  extend 
the  privilege  are  permitted  to  attend  public  worship  in 
the  city,  in  the  churches  of  the  various  denominations  to 
which  they  belong.  A  new  association  room  suitably  fur- 
nished accommodates  one  hundred  and  fifty  persons,  and 
here    lectures    and    entertainments    are  periodically    given. 


I08  ENGLAND. 

The  female  patients  assemble  once  a  week  for  reading, 
music,  games,  and  social  intercourse.  Permission  is  occa- 
sionally granted  to  some  of  the  patients  to  visit  places  of 
amusement  in  York. 

At  the  time  of  my  visit,  the  records  showed  153  patients 
— 64  men  and  89  women.  The  accommodation  afforded  is 
dependent  more  upon  mental  condition  than  upon  the  scale 
of  payment.  While  some  are  provided  for  gratuitously,  the 
prices  paid  for  maintenance  of  others  range  from  trivial  sums 
to  as  high  as  ^^400  per  annum.  The  average  cost  of  support 
is  about  325.  per  week. 

Two  padded  rooms — one  for  each  sex — are  provided  in 
case  of  need.  These  are  so  fitted  up  as  to  obviate  the 
possibility  of  injury.  Locked  dresses  are  not  used,  although 
strong  garments  are  sometimes  put  on  when  patients  are 
sent  to  their  rooms  during  paroxysms.  Order  prevailed 
throughout  the  asylum,  and  the  surroundings  were  quiet. 

A  feature  of  the  management  is  the  "  autumnal  trip  " 
made  every  year  to  the  sea-side  by  patients  in  charge  of 
the  Superintendent  or  some  of  his  staff.  Instead  of,  as 
heretofore  on  such  occasions,  procuring  accommodations 
in  expensive  lodgings,  a  house  has  recently  been  leased  in 
Scarborough,  where  those  likely  to  be  benefited  by  a  change 
may  enjoy  the  salubrious  air  of  the  Yorkshire  coast. 

A  full  inspection  of  the  Retreat,  with  its  detached  cot- 
tages, its  artfully  screened  walls,  its  beautiful  recreation 
grounds,  and  its  wealth  of  flowers  within  and  without,  suf- 
fices to  convince  the  visitor  that  this  small  and  select  institu- 
tion, which  well-nigh  a  hundred  years  ago  proved  such  a 
powerful  factor  in  educating  and  elevating  public  opinion  in 
England,  retains  to  this  day  much  of  that  progressive  spirit 
and  humanity  of  purpose  upon  which  its  world-wide  reputa- 
tion rests. 


CHAPTER  III. 
SCOTLAND. 

THE  present  admirable  Scotch  lunacy  system  dates 
from*  August  25,  1857.  Looking  backward  from  that 
time,  we  see  little  in  the  history  of  the  treatment  of  the 
insane  in  Scotland  that  is  worthy  of  commendation,  if  we 
except  what  was  accomplished  in  their  behalf  through  pri- 
vate benevolence.  The  peculiar  superstitions  of  the  people 
at  one  time  contributed  to  the  record  of  cruelties  perpe- 
trated upon  this  unfortunate  class. 

Allusion  has  already  been  made  to  the  fact  that  the  insane 
were  sometimes  put  to  death  under  the  belief  that  they  were 
witches.  The  last  instance  of  this  kind  in  Scotland  is  re- 
corded by  Sir  Walter  Scott  as  having  taken  place  in  1722, 
and  is  thus  described  :  "  A  sheriff-depute  of  Sutherland, 
Captain  David  Ross,  of  Littledean,  took  it  upon  him,  in 
flagrant  violation  of  the  then  established  rules  of  jurisdic- 
tion, to  pronounce  the  last  sentence  of  death  for  witchcraft 
which  was  ever  passed  in  Scotland.  The  victim  was  an 
insane  old  woman,  belonging  to  the  parish  of  Loth,  who 
had  so  little  idea  of  her  situation  as  to  rejoice  at  the  sight 
of  the  fire  which  was  destined  to  consume  her.  She  had  a 
daughter  lame  of  both  hands  and  feet,  a  circumstance  attrib- 
uted to  the  witches  having  been  used  to  transform  her  into  a 
pony,  and  get  her  shod  by  the  devil."  It  does  not  appear 
that  any  punishment  was  ever  inflicted  for  this  cruel  abuse 
of    law    on    the    person    of    a    creature    so    helpless.     Scott 

109 


no  SCOTLAND, 

also  relates  that  the  son  of  the  lame  daughter,  he  himself 
distinguished  by  the  same  misfortune,  was  in  later  years  a 
beneficiary  of  the  Marchioness  of  Stafford. 

As  an  illustration  of  the  inhuman  treatment  of  the  insane 
at  a  later  period,  one  method  of  incarceration  is  here  given, 
as  described  by  Dr.  Robert  Gardiner  Hill:  "At  Inverness, 
between  the  second  and  third  arches  of  the  old  bridge,  built 
in  1685,  there  is  a  dismal  vault,  used  first  as  a  jail  and  after- 
wards as  a  mad-house.  This  appalling  place  of  durance, 
where  the  inmates  were  between  the  constant  hoarse  sound 
of  the  stream  beneath,  and  the  occasional  trampling  of  feet 
and  rattling  of  wheels  overhead,  existed  as  late  as  181 5,  and 
is  said  not  to  have  been  abandoned  till  its  last  miserable  in- 
mate, a  maniac,  had  been  devoured  by  rats." 

During  the  latter  part  of  the  eighteenth  and  the  early  part 
of  the  nineteenth  century  the  state  of  the  insane  poor  was 
one  of  wretchedness  and  neglect.  In  1818  there  were  in  all 
Scotland  only  about  two  hundred  and  fifty  insane  persons 
provided  for  in  public  asylums  and  about  one  hundred  and 
fifty  in  private  asylums.  Twenty  years  later  the  condition 
of  this  class  was  not  much  improved.  There  was  a  lam- 
entable insufficiency  of  asylum  accommodation.  Large 
numbers  of  the  insane  were  shut  up  in  private  dwellings, 
without  official  supervision  ;  others  were  restricted  to  poor- 
houses  with  no  special  provision  for  their  care ;  some  were 
confined  in  jails;  and  a  few,  including  even  the  violent  and 
dangerous,  were  living  alone  or  were  permitted  to  roam 
about  the  country. 

While  there  existed  a  reprehensible  reluctance  on  the 
part  of  the  State  to  discharge  its  obligations  to  the  insane, 
it  is  gratifying  to  note  some  noble  manifestations  of  private 
generosity  in  their  behalf.  The  opening  of  the  Royal  Ed- 
inburgh Asylum  in  18 13  was  the  result  of  individual  effort. 


BENE  VOLE  NT  EFFOR  TS.  1 1 1 

Here,  from  the  outset,  an  intelligent  and  humane  system 
of  treatment  was  pursued  and  an  opportunity  offered  for 
the  study  of  mental  diseases.  Murray's  Royal  Asylum  at 
Perth  was  erected  out  of  funds  bestowed  by  the  benefactor 
whose  name  it  bears.  The  Crichton  Institute  at  Dumfries, 
opened  in  1839,  was  endowed  with  upwards  of  $500,000  left 
by  Dr.  Crichton  for  charitable  purposes.  Previous  to  1855 
seven  chartered  asylums,  called  "  Royal,"  had  been  founded 
by  private  charity,  but  no  government  aid  had  been 
granted,  except  i^2,ooo  to  the  Royal  Edinburgh  Asylum 
at  Morningside.  These  institutions  had  expended  on  lands, 
buildings,  and  furniture  ^^352, 632,  in  making  provision  for 
both  pauper  and  private  patients.  But  these  generous 
efforts  were  wholly  inadequate  to  meet  the  wants  of  the 
insane. 

The  first  parliamentary  legislation  to  regulate  the  con- 
finement and  treatment  of  lunatics  in  Scotland  was  the  Act 
55  George  III.  c.  69,  passed  in  1815.  This  was  followed  by 
the  enactment  of  statutes  for  the  same  purpose  in  1829  and 
1 841.  These  several  acts,  which  may  be  said  to  have  formed 
the  Scottish  code  of  lunacy,  were  so  ambiguously  framed 
and  so  contradictory  in  many  of  their  provisions  that  there 
was  great  difficulty  in  administering  them.  It  was  not 
until  1855  that  any  effective  movement  was  set  on  foot 
to  establish  a  humane  and  comprehensive  lunacy  system. 
And  here  it  may  be  proper  to  mention  that  the  people 
of  Scotland  are  indebted  to  the  philanthropic  labors 
of  Miss  Dix  for  originating  the  great  reform  begun  at 
that  time.  This  estimable  lady,  in  relating  to  the  writer 
some  of  her  experiences  while  endeavoring  to  improve 
the  condition  of  the  insane  in  foreign  lands,  told  him  of 
her  efforts  in  Scotland.  It  appeared  from  her  account 
that    she   was  greatly  shocked    at  the  condition    in    which 


112  SCOTLAND. 

she  found  the  insane  in  that  country,  and  was  much  dis- 
turbed because  of  the  difficulties  she  encountered  in  gaining 
desired  information.  Finally  she  was  refused  admission  to 
an  asylum  that  she  particularly  desired  to  visit  at  night,  in 
order  to  learn  of  peculiar  abuses  that  she  believ^ed  were  hid- 
den from  the  public.  She  applied  to  a  high  official  in  Edin- 
burgh for  the  privilege  denied  her  by  those  in  charge  of  the 
institution.  Being  again  refused,  she  proceeded  at  once  to 
London  and  laid  before  the  Home  Secretary  the  startling 
facts  of  which  she  had  become  possessed  respecting  the  sad 
condition  of  the  insane  in  Scotland.  Notwithstanding  the 
sturdy  opposition  made  by  her  conservative  opponents,  the 
result  was  the  appointment  by  Parliament,  on  the  3d  of 
April,  1855,  of  the  famous  Royal  Commission,  "to  inquire 
into  the  condition  of  Lunatic  Asylums  in  Scotland,  and  the 
existing  state  of  the  law  in  that  country  in  reference  to 
Lunatics  and  Lunatic  Asylums." 

The  feeling  aroused  led  to  very  earnest  work  on  the  part 
of  the  Commissioners,  who  were  engaged  two  years  in  mak- 
ing investigations  and  preparing  their  report.  This  brought 
to  light  the  imperfections  of  existing  laws,  exposed  the  cru- 
elties to  which  the  insane  were  subjected,  and  opened  the 
way  for  the  excellent  lunacy  system  Scotland  now  enjoys. 

Concerning  the  chartered  asylums,  the  Commission  re- 
ported that  they  were  "  in  many  respects  in  a  highly 
satisfactory  state,"  that  the  management  was  disinterested, 
and  that  "  the  treatment  of  the  patients  was  liberal  and 
judicious,"  and,  "  on  the  whole,  deserving  of  commendation." 
In  these  institutions  the  monotony  of  asylum  life  was  broken 
by  frequent  excursions,  occasional  picnics,  concerts,  lectures, 
evening  parties,  and  dances,  and  in  a  few,  by  trips  to  the 
sea-side  in  summer.  There  was  some  adverse  criticism 
made,   however,   on   these    asvlums.     Some   of    them    were 


GOVERNMENTAL   INQUIRY.  II3 

overcrowded  and  were  imperfectly  warmed  and  ventilated. 
Refractory  patients  were  secluded  in  dark  cells  with  stone 
floors.  In  the  Montrose  asylum  dirty  and  destructive 
patients  were  permitted  to  remain  entirely  naked  while  in 
seclusion,  loose  straw  being  cast  on  the  floor  for  bedding. 
Complaint  was  made  of  the  general  insufUciency  of  land 
attached  to  asylums,  the  absence  of  outdoor  as  well  as 
varied  indoor  employment,  and  a  lack  of  many  things  now 
considered  essential  in  asylums  for  the  insane. 

In  many  of  the  private  asylums  or  licensed  houses  the 
Commission  found  the  condition  of  the  insane  to  be  most 
deplorable,  the  principal  aim  of  the  proprietors  being  to 
secure  increased  profits.  The  patients  were  crowded  into 
small  apartments,  using  the  same  rooms  by  day  and  by  night, 
with  no  proper  separation  of  the  sexes,  and,  to  save  candle- 
light, kept  in  bed  the  greater  part  of  the  twenty-four  hours 
during  the  winter  months.  The  bedding  was  usually  of  a 
coarse  and  cheap  description,  insufficient  in  quantity,  and 
not  renewed  when  filthy.  It  was  stated  that  in  one  asylum 
women  patients  were  stripped  naked  at  night,  and  two, 
and  sometimes  three  were  made  to  sleep  in  the  same  bed- 
frame  on  loose  straw,  in  a  state  of  perfect  nudity.  The 
proprietor  of  another  establishment,  testifying  before  the 
Commission,  admitted  that  the  floors  at  night  were  soaked 
with  wet  ;  that  half  the  dirty  patients  slept  naked  ;  that 
seven  or  more  would  sleep  together  in  a  state  of  nudity ; 
and  yet  he  considered  this  proper  treatment  for  them. 
Comment  was  made  on  the  undue  use  of  restraint,  the 
lack  of  attendants  and  opportunities  for  proper  exercise, 
and  the  insufUciency  of  food  and  clothing. 

The  condition  of  the  insane  in  the  poorhouses  was,  as 
might  be  imagined,  unsatisfactory  in  the  extreme,  and  was 
the  subject  of  severe  criticism. 


Sobfrl  JituiJon  Sail 


114  SCOTLAND. 

The  report,  while  stating  that  the  details  furnished  gave 
but  an  imperfect  representation  of  the  true  condition  of 
the  insane  outside  of  institutions,  presented  an  appalling 
picture  of  the  amount  of  misery  suffered  by  this  class 
throughout  Scotland, 

It  is  true  the  law  provided  a  system  of  inspection  ;  but 
the  officers  entrusted  with  this  duty  were  strangely  derelict, 
and  the  Commission  found  it  necessary  to  report  that  most 
radical  measures,  amounting  to  an  entirely  new  system,  were 
requisite  to  meet  the  urgent  needs  of  the  time. 

Public  attention  was  directed  to  the  desirability  of  build- 
ing asylums  of  moderate  size  ;  to  the  great  benefits  of  fresh 
air,  healthful  exercise,  and  profitable  occupation  ;  and  also 
to  the  disadvantages  attending  the  then  too  frequent  prison- 
like construction  of  institutions  for  the  insane.  The  Com- 
mission recommended  that  asylums  should  be  more  home- 
like in  appearance ;  that  strong  wire  and  iron  enclosures 
should  be  abolished ;  and  that  more  attention  should  be 
paid  to  the  principles  of  heating  and  ventilation. 

The  outcome  of  this  report  was  the  Act  20  and  21  Vict, 
c.  71,  passed  August  25,  1857,  entitled  "An  Act  for  the 
Regulation  of  the  Care  and  Treatment  of  Lunatics,  and  for 
the  Provision,  Maintenance,  and  Regulation  of  Lunatic 
Asylums  in  Scotland."  In  accordance  with  this  memorable 
Act,  a  General  Board  of  Commissioners  in  Lunacy  for  Scot- 
land was  appointed,  and  the  country  was  divided  into 
asylum  districts.  It  was  required  that  asylums  for  the  in- 
sane poor  should  be  erected  where  necessary,  and  provision 
was  made  for  their  supervision  and  control. 

At  present  the  lunatics'  of  Scotland  are  provided  for  in 
Royal,  district,  and   parochial   asylums,  in  the  lunatic  wards 

'  As  in  England,  the  statutory  meaning  of  the  term  lunatic  includes  every 
person  of  unsound  mind  and  every  person  being  an  idiot. 


ESTABLISHMENTS  FOR  LUNATICS.  I15 

of  poorhouses,  in  private  asylums,  in  private  dwellings,  in 
training  schools  for  imbecile  and  idiotic  children,  and  in  the 
lunatic  department  of  the  State  Prison  at  Perth. 

The  seven  Royal  asylums  are,  strictly  speaking,  charitable 
institutions,  managed  by  unpaid  boards,  who  have  no  pecu- 
niary interest  in  their  prosperity.  All,  except  Murray's 
Royal  Asylum  at  Perth,  admit  pauper  as  well  as  pri- 
vate patients,  the  board, of  the  former  being  paid  by  paro- 
chial authorities,  and  that  of  the  latter  by  friends,  from  which 
sources  these  institutions  mainly  derive  their  support. 

The  district  asylums,  of  which  there  are  twelve,  are  public 
institutions,  and  were  built  from  assessments.  They  are 
managed  by  district  boards,  and  receive  only  pauper  pa- 
tients, unless  there  is  an  excess  of  accommodation.  Where 
there  is  an  excess,  it  may  be  used  for  patients  of  small  means, 
who  pay  but  little  more  than  the  rate  paid  by  the  parishes 
of  the  district  for  their  pauper  patients. 

The  parochial  asylums,  numbering  six,  have  been  erected 
out  of  taxes  levied  upon  the  parishes  to  which  they  belong. 
They  are  managed  by  parochial  boards,  and  receive  only 
pauper  patients. 

There  are  sixteen  lunatic  wards  of  poorhouses  having 
restricted  licenses,  in  which  are  received  only  harmless  and 
chronic  cases.  These  wards  are,  in  some  instances,  separate 
from  the  poorhouses,  and  may  be  regarded  as  detached 
asylums. 

There  are  six  small  private  asylums,  kept  either  by  medi- 
cal men  or  laymen,  which  are  licensed  by  the  Lunacy 
Board  to  receive  a  limited  number  of  patients.  The  private 
asylums  receive  only  private  patients,  and  are  required  to 
pay  ;^I5  each,  annually,  for  a  license. 

Besides  the  above-named  receptacles  for  lunatics,  both 
private  and  pauper  patients  are  received  into  private  dwell- 


Il6  SCOTLAND. 

ings  under  the  sanction  of  the  Commissioners  in  Lunacy. 
Not  more  than  four  patients  can  be  admitted  into  any- 
private  house,  and  a  license  is  required  if  more  than  one  is 
received. 

The  largest  asylum  in  Scotland  is  designed  to  accommo- 
date not  more  than  eight  hundred  patients,  the  others  being 
built  for  a  less  number,  in  accordance  with  a  prevailing 
opinion  in  favor  of  small  institutions. 

In  construction,  as  well  as  in  management,  the  public 
asylums  have,  during  the  past  few  years,  lost  much  of  their 
institutional  character,  and  have  correspondingly  gained  in 
public  estimation.  Walled  courts,  high  fences,  locked  doors, 
physical  or  mechanical  restraint,  and  the  use  of  stimulants 
and  narcotics  are,  to  a  great  extent,  discarded.  Among  the 
reforms  are  closer  and  more  intelligent  supervision,  the  sub- 
stitution, to  a  large  degree,  of  moral  for  physical  restraint, 
and  a  great  increase  of  industrial  occupations.  Considerable 
tracts  of  land  have,  during  late  years,  been  added  to  several 
of  the  more  important  institutions.  Farm  labor  is  found  to 
be  highly  beneficial  in  the  treatment  of  curable  as  well  as 
incurable  patients,  besides  proving  an  economical  source  of 
supply  to  the  asylums. 

The  headquarters  of  the  General  Board  of  Commissioners 
in  Lunacy  for  Scotland,  which  is  the  chief  authority  in 
lunacy  matters,  are  in  Edinburgh.  The  Board  consists  of 
five  commissioners,  who  are  assisted  by  a  secretary  and  a 
subordinate  force  of  clerks.  Three  of  the  commissioners,  in- 
cluding the  chairman,  are  unpaid.  The  paid  commissioners 
are  particularly  charged  with  the  work  of  visitation  and  in- 
spection. They  have  always  been  medical  men,  though  it 
is  not  specified  by  the  statute  that  they  shall  be.  Two  of 
the  unpaid  commissioners  have  always  belonged  to  the  legal 
profession,  although  this    is    not    required  by  law  ;  and   at 


LUNACY  SUPERVISION.  WJ 

present  a  baronet,  who  is  also  unpaid,  represents  the  laity 
in  the  capacity  of  chairman.  There  are  two  Deputy  Com- 
missioners whose  special  duty  it  is  to  visit  the  insane  in 
private  dwellings. 

By  the  action  of  the  legislature  large  powers  arc  given  to 
the  Lunacy  Board.  These  extend,  in  a  greater  or  less 
degree,  over  the  care  and  treatment  of  all  lunatics  in  public 
and  private  asylums,  in  the  lunatic  wards  of  poorhouses,  and 
all  pauper  patients  in  private  dwellings.  The  supervision  of 
the  Board  also  extends  to  every  non-pauper  insane  person 
who  is  kept  in  a  private  house  for  profit  and  suffers  from 
mental  disorder  of  a  confirmed  character  ;  or  who,  whether 
kept  for  profit  or  not,  has  been  insane  for  more  than  a  year 
and  is  subject  to  compulsory  confinement  to  the  house,  to 
restraint  or  coercion  of  any  kind,  or  to  harsh  and  cruel  treat- 
ment. The  supervision  of  the  Board  also  extends  to  those 
patients  who  are  possessed  of  property  which  has  been 
placed  in  charge  of  a  judicial  factor  by  a  court  of  law. 

The  Lunacy  Commissioners  are  authorized  to  grant,  re- 
new, or  suspend  the  licenses  of  private  asylums,  parochial 
asylums,  and  the  lunatic  wards  of  poorhouses.  They  are 
empowered  to  institute  inquiries,  to  summon  witnesses  with 
the  concurrence  of  the  Lord  Advocate,  to  examine  them  on 
oath,  and  to  direct  payment  of  their  reasonable  expenses. 
They,  or  at  least  two  of  them,  inspect  not  less  than  twice  a 
year  all  chartered,  district,  parochial,  and  private  asylums 
and  all  the  lunatic  wards  of  poorhouses,  as  also  the  insti- 
tutions for  idiots  and  the  department  for  insane  criminals  in 
the  prison  at  Perth.  They  are  authorized  to  employ  such 
medical  assistance  as  may  be  necessary,  and  are  required  to 
make  annually  a  report  of  their  work  and  proceedings  to 
the  Secretary  for  Scotland,  for  transmission  to  Parliament. 
The   Lord  Advocate,  who  is  the  chief  law  officer  for  Scot- 


Il8  SCOTLAND. 

land,  has  a  right  to  inspect  all  the  books  and  proceedings 
of  the  Board  of  Commissioners. 

The  procedure  under  the  Scotch  law  in  consigning  pa- 
tients to  asylum  care  is  the  same  whether  the  person  to  be 
admitted  is  possessed  of  property  or  is  a  pauper,  and  whether 
he  is  to  be  placed  in  a  public  or  in  a  private  asylum.  The 
statute  requires  that  the  officials  authorized  to  place  per- 
sons in  asylums  must  be  those  to  whom  are  entrusted  the 
power  of  taking  away  personal  liberty  for  other  reasons  than 
that  of  insanity.  Therefore  it  becomes  necessary  to  obtain 
the  order  of  the  sheriff '  before  a  private  or  a  pauper  patient 
can  be  permanently  received  into  any  asylum.  To  secure 
this,  some  person  must  petition  the  sheriff  to  grant  such 
order,  and  he  must  state  the  relation  in  which  he  stands  to 
the  patient.  The  petition  must  be  accompanied  by  a  writ- 
ten statement  of  particulars  signed  by  the  applicant.  It 
must  also  be  accompanied  by  two  certificates  granted  by 
registered  physicians,  setting  forth  that  they  have  sepa- 
rately examined  the  patient,  and  found  him  to  be  a  lunatic 
and  a  fit  person  to  be  placed  in  an  asylum.  The  sheriff's 
order  must  be  acted  on  within  fourteen  days  after  it  is 
granted,  unless  it  is  issued  in  the  Orkney  or  Shetland 
Islands,  in  which  event  twenty-one  days  are  allowed.  The 
petition  for  the  reception  of  a  pauper  patient  into  an 
asylum  is  usually  presented  to  the  sheriff  by  the  Inspector 
of  Poor. 

Within  seven  days  after  the  sheriff  issues  an  order  for  the 
reception  of  a  lunatic  into  any  asylum  or  house,  the  sheriff's 
clerk  must  send  notice  thereof  to  the  Lunacy  Board,  stating 
by  whom  the  application  was  made,  to  whom  the  order  ap- 
plied, giving  the  names  of  the  medical  men  who  signed  the 
certificates,  the  name  of  the  sheriff  who  granted  the   order, 

'  Under  the  statute  the  term  sheriff  includes  sheriff-substitute. 


ADMISSION. 


119 


and  the  name  of  the  asylum  or  house  to  which  the  patient 
is  to  be  admitted. 

Under  pressing  circumstances,  when  there  is  not  time  to 
obtain  the  sheriff's  order,  a  patient  may  be  received  into  an 
asylum  on  a  certificate  granted  by  one  registered  medical 
practitioner,  declaring  that  the  person  named  in  the  certifi- 
cate is  of  unsound  mind,  and  a  proper  person  to  be  placed  in 
an  asylum,  and  that  the  case  is  one  of  emergency.  This 
certificate  may  be  granted  by  the  medical  officer  of  the 
asylum  into  which  the  patient  is  to  be  received.  Within 
three  days,  however,  the  sheriff's  order  must  be  obtained  ; 
otherwise  the  detention  of  the  patient  becomes  illegal,  and 
he  must  be  discharged. 

When  it  comes  to  the  knowledge  of  an  Inspector  of  Poor 
that  there  is  a  pauper  lunatic  within  his  parish  who  has  not 
been  "  intimated  "  to  the  Lunacy  Board,  he  must  within  seven 
days  inform  the  Commissioners.  The  Inspector  of  Poor  must 
also  report  the  case  to  the  Chairman  of  the  Parochial  Board. 

The  insane  are  not  admitted  into  the  lunatic  wards  of 
poorhouses  unless  these  departments  have  been  licensed  by 
the  Commissioners  in  Lunacy,  and  are  governed  by  rules  and 
regulations  approved  by  them.  Nearly  all  of  the  inmates  of 
the  lunatic  wards  have  been  former  inmates  of  asylums, 
whence  they  have  been  transferred  by  an  order  of  the 
Lunacy  Board  granted  on  the  petition  of  the  Inspector  of 
Poor.  They  may,  however,  be  admitted  directly  b}-  an  order 
of  the  Lunacy  Board.  Both  in  the  case  of  transfer  and  of 
direct  admission  there  must  be  a  medical  certificate  stating 
that  the  patient  is  harmless  and  does  not  require  asylum 
care.  This  must  be  given  by  some  other  than  the  medical 
ofificer  of  the  poorhouse  in  which  it  is  proposed  to  place  the 
patient,  and  it  is  in  addition  to  the  two  establishing  his 
lunacy,  which  were  obtained  when  he  was  first  intimated  to 


I20  SCOTLAND. 

the  Board.  Patients  may  also  be  admitted  into  the  luna- 
tic wards  of  poorhouses  on  the  order  of  a  sheriff,  the  usual 
medical  certificates  having  been  obtained  ;  but  as  the  con- 
sent of  the  commissioners  is  likewise  necessary,  this  mode  of 
procedure  is  rarely  resorted  to.  No  patient  can  be  perma- 
nently admitted  except  by  the  sanction  of  the  Lunacy 
Board. 

Insane  persons  arrested  by  the  police  as  dangerous  or 
offensive  to  decency,  on  petition  of  the  public  prosecutor 
are  tried  before  the  sheriff,  and  if  found  to  be  insane,  are 
committed  by  him  to  asylum  care.  These  constitute  a 
very  small  percentage  of  the  insane. 

In  the  case  of  persons  of  property  becoming  insane,  the 
highest  legal  tribunal,  namely,  the  Court  of  Session,  is 
petitioned  upon  medical  evidence  to  appoint  a  judicial 
factor  to  take  charge  of  the  property  of  the  patient. 
This  having  recourse  to  a  legal  tribunal  whose  sittings 
are  in  Edinburgh,  proved  expensive  and  troublesome  in 
the  case  of  very  small  estates.  In  i88o,  therefore,  a  law 
was  passed  conferring  upon  sheriffs  or  their  substitutes  in 
the  several  sheriff  courts  in  Scotland  jurisdiction  in  all  such 
cases  where  the  yearly  value  does  not  exceed  ;^ioo. 

The  commissioners  have  power  to  grant  orders  for  access 
of  friends  to  patients,  and  these  orders  must  be  respected  on 
pain  of  a  fine  not  exceeding  ;^20. 

In  1862  an  act  was  passed  permitting  the  admission  to 
asylums  of  what  are  termed  "  voluntary  patients  "  ;  but  it 
proved  to  be  so  cumbersome  that  few  availed  themselves  of 
its  provisions.  In  1866  this  measure  was  repealed,  and  an- 
other having  a  like  object,  but  with  fewer  restrictions,  was 
enacted.  Under  the  law  as  it  now  stands  voluntary  patients 
are  not  registered  as  lunatics,  and  no  medical  certificate  is 
necessary  for  their  reception.     The  patient  must  make  the 


VOL  UN  TAR  Y  PA  TIENTS — DISCHARGE.  1 2 1 

application  himself  by  letter  addressed  to  the  Lunacy  Com- 
missioners specifying  the  asylum  he  wishes  to  enter,  and 
with  their  sanction  the  superintendent  is  authorized  to 
admit  the  applicant.  After  becoming  an  inmate,  the  pa- 
tient is  permitted  to  leave  the  asylum  at  any  time  by 
giving  three  days'  notice.  Some  persons  admitted  as  vol- 
untary patients  are  afterwards  found  to  be  insane,  and  while 
remaining  in  the  asylum  are  regularly  committed  by  a 
sherifT's  order.  In  such  cases,  however,  a  special  examina- 
tion is  previously  made  by  the  commissioners. 

Respecting  the  operation  of  this  law  the  commissioners 
say  in  a  late  report : 

"  We  have  for  some  years  been  able  to  state  that  nothing  has 
occurred  to  indicate  any  difificulty  or  disadvantage  traceable  to  the 
presence  of  this  class  of  patients  in  asylums  ;  and  we  continue  to 
be  of  opinion  that  it  is  a  useful  provision  of  the  law  which  permits 
persons  who  desire  to  place  themselves  under  care  in  an  asylum 
to  do  so  in  a  way  which  is  not  attended  with  troublesome  or  dis- 
agreeable forms,  but  which  nevertheless  affords  sufficient  guar- 
antee against  abuse.  At  the  visits  of  the  medical  commissioners 
to  asylums  all  voluntary  inmates  are  seen,  and  they  have  then  an 
opportunity  of  making  statements  in  regard  to  their  position, 
should  they  desire  to  make  any.  When  there  is  reason  to  sup- 
pose that  they  in  any  way  fail  to  understand  the  conditions  of 
their  residence,  we  consider  it  proper  to  explain  these  conditions  ; 
but  we  have  never  found  that  the  nature  of  their  position  has 
been  intentionally  concealed  from  them." 

The  manner  of  releasing  patients  from  asylum  care  in 
Scotland  differs  materially  from  that  of  England,  and  is 
worthy  of  careful  consideration.  The  Scotch  method  has 
been  succinctly  explained  by  Dr.  Mitchell,  one  of  the  Com- 
missioners in  Lunac}'  for  Scotland,  as  follows  : 

"  The  very  fact  of  restoration  to  sanity  makes  the  detention  of 
a  patient  illegal.  No  particular  procedure,  however,  is  laid 
down  by  the  law   for  such   a  case.     The  superintendent  simply 


122  SCOTLAND. 

discharges  the  patient  as  recovered,  and  gives  notice  of  the  dis- 
charge to  the  Board.  If  the  patient  thinks  that  he  is  still  detained, 
though  he  has  reached  a  state  of  sanity,  he  can  appeal  to  the 
Board,  who  can  order  his  discharge,  on  being  satisfied  by  the 
certificate  of  two  medical  persons,  whom  they  may  think  fit  to 
consult,  of  his  recovery  or  sanity.  The  Board  cannot  order  the 
discharge  of  any  patient  of  whose  complete  restoration  or  sanity 
they  are  not  thus  satisfied  ;  but  it  is  a  provision  of  the  law  that 
any  person  having  procured  and  produced  the  certificate  of  two 
medical  persons,  approved  by  the  sheriff,  either  of  the  recovery 
of  any  patient,  or  bearing  that  the  patient  may,  without  risk  of 
injury  to  himself  or  the  public,  be  set  at  large,  may  petition  the 
sheriff  to  order  his  discharge,  which  order  the  sheriff  is  em- 
powered to  grant.  This  procedure  relates  both  to  recovered  and 
unrecovered  patients.  The  Board  can  thus  only  discharge  re- 
covered patients,  but  the  sheriff  can  discharge  both  recovered  and 
unrecovered.  The  commissioners  and  the  sheriff  alike  require 
to  have  the  condition  of  the  patient  testified  to  by  medical  men  of 
whom  they  approve.  The  commissioners  do  not  act  on  their  own 
opinion,  except  in  so  far  as  it  falls  to  them  to  determine  whether 
there  is,  prima  facie,  a  case  for  inquiry  ;  in  other  words,  whether 
medical  men  should  be  sent  to  examine. 

"  Again,  the  sheriff's  order,  on  which  a  patient  is  received  into 
an  asylum,  is  not  now  of  unlimited  duration.  It  does  not  remain 
in  force  longer  than  the  ist  of  January,  first  occurring  after  the 
expiry  of  three  years  from  the  date  on  which  it  was  granted,  or 
than  the  first  day  of  January  of  each  following  year,  unless  the 
medical  superintendent  of  the  asylum  in  which  the  patient  is  kept 
shall  on  each  of  the  said  first  days  of  January,  or  within  fourteen 
days  preceding,  grant  and  transmit  to  the  Board  a  certificate  that 
on  a  careful  review  and  consideration  of  the  case,  he  is  of  opinion 
that  continued  detention  is  necessary  and  proper.  This  provision 
is  intended  to  secure  a  careful  yearly  revision  of  the  condition  of 
patients  who  have  been  three  years  or  more  in  asylums,  and  a 
formal  expression  of  opinion  regarding  it,  and  in  the  opinion  of 
the  Board  it  is  a  provision  which  practically  does  good.  If  the 
certificate  is  not  granted,  the  patient  is  ipso  facto  discharged  ; 
the  certificate  especially  declares  that  the  continued  detention  of 
the  patient  is  necessary  and  proper. 

"  Private  patients  can  be  taken  out  of  asylums  at  any  time  by 


SUPERINTENDENT' S   CERTIFICATE.  1 23 

their  friends  ;  but  the  superintendent,  if  he  thinks  the  discharge 
of  the  patient  would  be  attended  with  danger,  may  appeal  to  the 
public  prosecutor  to  interpose  his  authority  and  deal  with  the 
patient  as  a  dangerous  lunatic.  On  the  other  hand,  a  superin- 
tendent can  force  the  friends  or  guardians  of  a  patient,  whether 
private  or  pauper,  to  remove  him,  if  he  thinks  he  has  so  far 
recovered  that  he  may  be  liberated  without  risk  to  the  public  or 
himself.  If  his  opinion  as  to  the  liberation  of  such  a  patient  is 
resisted  by  the  friends  or  guardians,  he  can  appeal  to  the  Board, 
who,  on  satisfying  themselves  that  his  opinion  is  correct,  can 
order  the  discharge  of  the  patient.  The  relations  and  powers  of 
parochial  authorities  in  regard  to  pauper  lunatics  have,  by  the 
later  amendments  of  the  Scotch  Lunacy  Acts,  been  made  as  simi- 
lar as  possible  to  the  relations  I  have  just  described  as  existing 
between  private  patients  and  their  friends.  The  removal  of 
pauper  lunatics  by  parochial  authorities  is  not  much  more  diffi- 
cult than  the  removal  of  private  patients  by  their  friends  ;  but 
when  any  pauper  lunatic  is  removed  as  unrecovered,  the  Board 
require  information  from  the  parochial  authorities  as  to  whether 
parochial  relief  is  still  extended  to  him,  and  if  it  is,  then  the 
arrangements  made  for  the  patient's  care  must  be  submitted  to 
the  Board  for  their  approval  and  sanction.  He  remains  under 
the  jurisdiction  of  the  Board  as  a  patient  in  a  private  dwelling- 
house,  and  is  visited  by  the  Deputy  Commissioners  from  time  to 
time.  The  return  of  such  a  patient  to  the  asylum  can  be  ordered 
by  the  Board  at  any  time.  In  this  way  no  injury  can  be  done  to 
pauper  patients  by  the  considerable  powers  which  are  given  to 
parochial  boards  in  regard  to  their  removal  from  asylums  ;  on  the 
other  hand,  the  advantages  both  to  patients  and  to  parochial  boards 
from  these  powers  are  important." 

Persons  committed  as  dangerous  lunatics  are  not  liberated 
without  the  approval  of  the  public  prosecutor. 

Every  released  person  who  may  consider  himself  to  have 
been  unjustly  confined  is  entitled  to  receive  a  copy  of  the 
order,  certificate,  etc.,  upon  which  he  was  committed. 

The  certificate  of  the  surperintendent  or  medical  attend- 
ant, which  is  necessary  to  detain  a  patient  in  an  asylum 
longer  than  the  "  ist  of  January,  first  occurring  after  the 


124  SCOTLAND. 

€xpiry  of  the  three  years  from  the  date  on  which  it  was 
granted,  or  than  the  first  day  of  January  of  each  following 
year,"  is  in  accordance  with  section  7  of  the  Act  29  and  30 
Vict.  c.  51,  and  is  in  the  following  form  : 

"  I  hereby  certify,  on  soul  and  conscience,  that  I  have,  within 
a  period  not  exceeding  one  month  preceding  the  date  of  this 
certificate,  carefully  reviewed  and  considered  the  cases  of  the 
patients  whose  names  are  subjoined,  and  I  am  of  opinion  that 
their  continued  detention  in  the  asylum  is  necessary  and  proper 
for  their  own  welfare  (or,  for  the  public  safety,  as  the  case  may 
be)." 

Superintendents  have  power  without  the  consent  of  the 
Lunacy  Commissioners  to  liberate  patients  on  trial  for  a 
term  not  exceeding  twenty-eight  days.  This  practice  has 
proved  so  beneficial  that  it  is  regarded  with  increasing 
favor. 

In  some  asylums  it  is  customary  to  release  patients  on 
probation  for  periods,  usually,  of  from  three  to  six  months. 
This  can  be  done  only  by  the  consent  in  each  case  of  the 
Lunacy  Commissioners.  During  his  absence  from  the  asy- 
lum the  patient  is  subject  to  the  inspection  of  the  Board, 
and  if  a  pauper  lunatic,  his  name  cannot  be  taken  off 
the  poor-roll.  If  necessary  he  can  at  any  time  be  returned 
to  the  asylum.  Probationary  removals  were  first  authorized 
in  1862,  and  from  that  time  to  the  close  of  1886  there  were 
2,982  patients  thus  temporarily  discharged,  530  of  whom 
were  returned  to  the  asylum  before  the  expiration  of  the 
period  of  probation. 

Respecting  this  excellent  provision  of  the  Scotch  statute, 
the  Lunacy  Commissioners  say  ; 

"  The  special  use  of  the  statutory  discharge  on  probation  is  to 
permit  of  the  conditional  liberation  of  patients  whose  fitness  for 
permanent  discharge  cannot  be  determined  without  actual  trial, 


PROBATIONARY  DISCHARGE.  125 

under  the  conditions  of  ordinary  life,  for  longer  periods  than 
twenty-eight  days.  It  is  frequently  found  that  patients,  who  ap- 
pear while  in  the  asylum  to  have  improved  so  much  that  they  are 
fit  for  being  provided  for  in  private  dwellings,  become  unsettled 
when  the  restraints  of  the  asylum  are  removed.  It  is  not,  how- 
ever, justifiable  to  retain  permanently  in  the  asylum  all  patients  in 
whose  cases  a  possibility  of  such  unsettlement  is  thought  to  exist. 
The  large  majority  of  patients  discharged  on  probation  undergo 
no  deterioration,  and  many  are  benefited  by  the  change.  By  dis- 
charging patients  on  probation  there  is  an  opportunity  for  testing 
their  fitness  for  permanent  discharge,  and  at  the  same  time  for 
replacing  them  in  the  asylum  without  the  expense  attending  a 
sheriff's  order,  if  they  prove  unfit  for  permanent  discharge.  We 
continue  to  be  of  opinion  that  in  some  establishments  a  more  fre- 
quent application  of  the  probationary  discharge  to  patients  whose 
fitness  for  residence  in  private  dwellings  maybe  uncertain,  would 
lead  to  a  larger  number  of  permanent  discharges  than  takes  place 
at  present." 

A  penalty  not  exceeding  ;^iOO,  or  imprisonment  not  ex- 
ceeding six  months,  may,  without  prejudice  to  action  for 
damages,  be  inflicted  upon  officers  or  employees  of  any 
public,  private,  or  district  asylum  or  house,  who  shall  wil- 
fully maltreat,  abuse,  or  neglect  any  person  detained  therein 
as  a  lunatic  patient.  The  public  prosecutor  deals  with  such 
cases.  Penalties  are  recoverable  before  the  sheriff  for  mak- 
ing false  statements  or  returns,  or  for  refusal  to  give  infor- 
mation as  required  by  law. 

Respecting  medical  attendance  upon  patients  under  asy- 
lum care,  it  is  required  that  all  asylums  licensed  for  one 
hundred  or  more  patients  must  have  a  resident  physician  ; 
those  licensed  for  more  than  fifty  and  less  than  one  hundred 
need  not  have  a  resident  medical  officer,  but  they  must  be 
visited  daily  by  a  medical  man.  Those  as}-lums  licensed  for 
fifty  or  less  than  fifty  patients  must  be  visited  twice  a  week 
by  a  medical  man.  The  Lunacy  Board  have  power  to 
increase  the  number  of  visits,  and  they  ma\'  require  a  resi- 


126  SCOTLAND. 

dent  physician  to  be  appointed  to  any  asylum  licensed  for 
more  than  fifty  patients.  It  is  provided,  however,  that  the 
commissioners  may  give  permission  to  visit  houses  licensed 
for  fewer  than  eleven  patients  less  frequently  than  twice  a 
week,  but  not  less  frequently  than  once  in  every  two  weeks. 

Out  of  an  estimated  population  of  3,949,393  in  Scotland 
January  i,  1887,  there  were  under  cognizance  of  the  Lunacy 
Board  11,309  lunatics.  This  gives  the  proportion  of  luna- 
tics to  the  whole  population  as  i  to  349.  In  1867,  it  was  as 
I  to  469.  In  1858,  the  proportion  was  as  i  to  517.  While 
the  number  of  lunatics  coming  under  the  supervision  of  the 
Lunacy  Board  during  the  period  from  1858  to  the  date  of 
January  i,  1887,  increased,  according  to  the  estimate  of  the 
Board,  96  per  cent,  the  growth  of  the  population  during 
the  same  period  was  only  31  per  cent.  The  commissioners 
state,  however,  that  this  increase  does  not  necessarily  indi- 
cate an  increasing  amount  of  mental  disease,  but  that  they 
consider  it  due,  in  a  large  measure,  to  a  growing  readiness 
to  place  persons  more  or  less  disordered  in  mind  in  lunatic 
establishments. 

The  11,309  lunatics  under  the  cognizance  of  the  Scotch 
Lunacy  Board  on  the  1st  of  January,  1887,  were  distributed 
as  follows  :  In  the  seven  royal  asylums  there  were  3,184  ;  in 
the  twelve  district  asylums,  3,142  ;  in  private  asylums,  128  ; 
in  parochial  asylums,  1,444;  i'"^  ^^^c  lunatic  wards  of  poor- 
houses,  857 ;  in  private  dwellings,  2,270 ;  in  the  lunatic 
department  of  the  general  prison  at  Perth,  56;  and  in  the 
training  institutions  for  imbeciles  or  idiots,  228.  Of  the 
above  total,  9,514  are  maintained  out  of  parochial  rates, 
1,739  from  private  sources,  and  56  at  the  expense  of  the 
State. 

During  the  year  ending  May  14,  1887,  the  average  weekly 
per-capita  cost  of  maintenance  of  pauper  lunatics  in  royal, 


INTERVIEW    WITH  COMMISSIONER.  12/ 

district,  private,  and  parochial  asylums,  and  schools  for  im- 
beciles was  lO^.  o\d. ;  in  lunatic  wards  of  poorhouses,  'js. ;  in 
private  dwellings,  55-.  \od. 

The  government  grant  of  four  shillings  per  capita  per 
week  toward  the  maintenance  of  pauper  lunatics,  begun  in 
1874,  has  been  a  powerful  means  of  raising  the  standard  of 
care  for  the  needy  insane.  It  increased  from  ^^59,483  in  1875 
to  ^^88,258  in  1887.  The  terms  of  the  grant  are  somewhat 
peculiar.  It  is  not  a  uniform  one  of  four  shillings  per 
capita.  When  the  actual  expenditure  for  a  patient  falls 
below  eight  shillings  per  week,  only  half  the  amount  ex- 
pended is  allowed  by  the  government.  In  Scotland  this 
grant  extends  to  the  lunatic  wards  of  poorhouses.  An 
examination  of  these  wards  impresses  one  with  their  superi- 
ority to  the  generality  of  poorhouse  provision,  this  superior- 
ity being  due,  perhaps,  to  the  fact  that  the  poorhouses  are 
under  the  direction  of  boards  of  intelligent  and  unpaid 
managers  ;  yet  in  no  case  did  it  appear  to  the  writer  that  the 
standard  of  care  was  equal  to  that  of  asylums. 

The  following  information,  which  further  illustrates  the 
workings  of  the  Scotch  lunacy  system  and  its  somewhat 
novel  features,  the  writer  obtained  in  an  interview  with  Dr. 
Sibbald,  one  of  the  commissioners: 

"  Our  Board  is  called  the  General  Board  of  Commissioners  in 
Lunacy  for  Scotland.  Each  district  has  its  district  board.  Each 
town  is  governed  by  its  municipality,  which  is  a  representative 
body  ;  but  outside  the  towns  affairs  are  managed  by  Commission- 
ers of  Supply,  consisting  of  all  persons  possessed  of  land  over 
the  value  of,  I  think,  ^200  a  year.  They  meet  twice  a  year  in  a 
kind  of  small  parliament,  and  they  have  the  appointment  of  all 
the  local  boards,  such  as  the  District  Board  of  Lunacy,  also  the 
board  managing  the  police  regulations  of  the  district, — every 
thing  of  this  kind  is  under  their  control.  They  appoint  commit- 
tees of  their  number  to  attend  to  local  matters  ;  and  one  of  these 


128  SCOTLAND. 

committees  is  called  the  District  Board  of  Lunacy.  This  board 
has  to  erect  the  district  asylum,  keep  it  in  repair,  appoint  officers, 
and  see  that  there  is  accommodation  for  all  the  lunatic  poor 
of  the  district.  It  does  not  provide  the  maintenance  for  the 
lunatics,  because  each  parish  pays  for  its  own  ;  it  simply  pro- 
vides the  building,  furnishes  it,  and  appoints  officers  for  the 
district. 

"  Some  of  the  districts,  of  which  there  are  twenty-two,  are  large 
and  others  small.  Sometimes  a  portion  of  a  county,  sometimes  a 
county,  and  sometimes  a  congeries  of  counties  forms  a  district. 
The  members  of  the  district  boards  have  under  their  charge  the 
building  and  government  of  the  district  asylums  ;  they  decide  what 
the  supply  shall  be  ;  they  present  to  the  meetings  of  the  Com- 
missioners of  Supply  the  amount  required  for  the  year  ;  but,  on 
these  matters,  they  report  to  us  first,  and  we  give  authority  to 
levy  the  assessment.  They  cannot  levy  without  our  approval. 
The  boards  differ  in  size, — the  smallest  numbering  seven,  and  the 
largest  thirteen  members.  They  are  unpaid.  Practically  they 
cannot  put  up  a  building  without  our  approval.  They  have  a  great 
deal  of  liberty  nominally  ;  but  they  are  under  the  influence  of 
public  opinion.  If  they  were  to  do  any  thing  which  the  public 
thought  wrong,  then,  at  the  meeting  of  the  Commissioners  of 
Supply  in  all  probability  they  would  be  turned  out  and  others 
appointed.  We  are  required  to  make  a  full  report  on  these  asy- 
lums, and  our  report  is  printed. 

'*  At  the  time  the  first  of  what  are  known  as  the  Lenzie  Acts 
was  passed,  certain  bodies  had  already  provided  asylums.  Some 
of  them  were  corporations  established  as  charitable  institutions. 
They  received  a  certain  number  who  could  not  pay  any  thing, 
and  also  those  who  desired  to  be  admitted  and  were  willing  to  pay 
for  their  maintenance.  Among  these  charitable  foundations  were 
the  institutions  at  Morningside,  Dumfries,  Montrose,  Gartnavel, 
and  Aberdeen, — all  chartered  asylums.  That  at  Aberdeen  is  also 
the  district  asylum  for  Aberdeenshire. 

"  There  were  also,  at  that  time,  some  of  the  larger  parishes 
which  had  provided  asylums  for  their  poor  people.  The  Glas- 
gow parishes  may  be  cited — three  large  parishes,  Govan  being 
one.  Govan  had  not  made  such  provision,  but  the  Barony  parish 
of  Glasgow  had  to  a  small  extent.  It  could  boast  of  a  small 
asylum — not  a  good  one,  it  is  true  ;   still  it  was  in  the  position  of 


INTERVIEW    WITH  COMMISSIONER.  129 

having  provided  accommodation  for  its  lunatic  poor.  In  terms 
of  the  Act  of  Parliament,  those  parishes  which  had  so  provided 
were  to  be  allowed,  if  they  made  suitable  arrangements,  to  con- 
tinue to  make  provision,  if  they  desired  to  do  so.  The  present 
Lenzie  Asylum  is  the  outgrowth  of  that  legislation.  There  they 
have  the  management  vested  in  the  parochial  board  and  a  com- 
mittee of  that  board  under  our  supervision.  There  is  no  district 
board  to  supervise  them.  They  require  only  to  apply  to  us  every 
year  for  a  license  to  keep  their  asylum  open.  If  the  asylum  was 
badly  conducted,  it  would  be  our  duty  to  refuse  the  license. 
Certain  other  parish  institutions  might  be  named,  as,  for  example, 
the  asylums  of  Abbey,  Paisley,  and  Greenock.  These  are  paro- 
chial asylums  like  Lenzie,  which  provide,  among  them,  for  all  the 
parishes  of  Renfrewshire,  whose  district  board  has  consequently 
no  functions.  It  exists  on  paper,  but  that  is  all.  If  these  par- 
ishes were  to  fail  to  provide  for  the  wants  of  the  county  in  regard 
to  the  insane,  the  district  board  could  be  called  into  existence, 
and  might  make  provision  ;  but,  at  present,  that  is  not  necessary. 
The  remaining  parishes  of  Renfrewshire  have  made  agreement 
with  the  three  which  possess  asylums.  Each  of  these  three, 
therefore,  has  a  certain  number  of  parishes  associated  with  it,  and 
forms  practically,  though  not  technically,  a  little  district. 

"  In  Glasgow,  to  which  Lenzie  belongs,  you  have  a  very  differ- 
ent class  of  patients  from  what  would  be  found  in  such  a  county 
as  Fife,  Aberdeenshire,  or  Inverness-shire.  They  are  accustomed 
to  different  kinds  of  work,  and  they  are  generally  a  rougher  class 
in  the  towns.  The  lower  stratum  of  a  town  is  generally  lower 
than  that  of  a  rural  district. 

"  With  regard  to  asylums,  each  patient  is  admitted  on  applica- 
tion to  the  sheriff,  who  is  the  county  judge.  A  statement  of  the 
case  with  two  medical  certificates  is  sent  to  our  office  from  the 
asylum  superintendent  after  the  patient  has  been  admitted.  The 
superintendent  reports  upon  the  mental  condition  of  the  patient, 
so  as  to  indicate  that  he  considers  the  person  to  be  a  proper  sub- 
ject for  asylum  treatment.  Therefore  we  have  not  only  the  assur- 
ance of  the  two  medical  men  who  sent  the  patient,  in  believing 
him  to  be  insane,  but  we  have  the  additional  assurance  of  the 
superintendent.  If  we  find  the  person  described  simply  as  rest- 
less and  disinclined  to  work,  we  write  back  asking  the  superin- 
tendent whether  he  considers  him  insane.      If  the  superintendent 


130  SCOTLAND. 

is  still  unable  to  give  a  more  definite  opinion,  we  say  :  '  Report 
again  in  a  month.'  If,  at  the  end  of  that  period,  he  is  still  unable 
to  certify  to  the  person's  insanity,  we  say  :  *  Send  him  out.'  We 
also  require  from  superintendents  a  report  on  the  physical  condi- 
tion, to  show  whether  the  patient,  on  admission,  bore  marks  of 
having  sustained  injuries.  We  have  different  kinds  of  reports 
from  different  asylums.  In  case  of  injury  during  confinement, 
the  superintendent  is  required  to  report  the  condition  of  the 
patient  and  the  date  of  the  injury. 

"  With  regard  to  transfers  from  an  asylum,  practically,  we  can  * 
transfer  a  patient  should  we  have  reason  to  believe  that  he  would 
be  more  benefited  by  being  boarded  out  or  placed  in  some  other 
institution  ;  but  such  a  thing  would  only  be  done  after  one  of  our 
visits  of  inspection — after  we  had  seen  the  patient,  and  it  appeared 
to  the  inspector  that  he  did  not  seem  to  require  asylum  treatment. 
The  visiting  inspector  w^ould  first  discuss  the  matter  with  the 
superintendent.  If  the  discussion  was  not  satisfactory,  the 
man  would  probably  be  visited  again  or  examined  by  some  one 
else." 

Family  care,  or  boarding-out,  as  it  is  called,  is  an  important 
feature  of  the  Scotch  system,  there  being,  as  already  indi- 
cated, about  one  fifth  of  the  Scottish  insane  provided  for  in 
this  way.  On  the  1st  of  January,  1887,  those  in  private 
dwellings  numbered  882  males  and  1,388  females,  being,  as 
compared  with  the  foregoing  year,  an  increase  of  92.  Of  the 
total,  130  were  private  and  2,140  pauper  patients.  The 
Deputy  Commissioners  in  visiting  these  widely  scattered 
patients,  many  of  whom  are  in  remote  parts  of  the  country, 
perform  a  laborious  task  unparalleled  in  the  history  of 
lunacy  supervision. 

It  is  claimed  that  the  boarding-out  of  pauper  patients  in 
the  residences  of  small  farmers  affords  a  convenient  outlet 
for  the  over-accumulation  of  chronic  cases  in  asylums, 
besides  conferring  upon  the  insane  the  great  benefits  of  lib- 
erty, air,  and  exercise.  The  weekly  cost  per  capita  has  been 
estimated  at  about  four  shillings  below  the  average  asvlum 


BOARDING-OUT.  I3I 

cost.     A  low  rate  of  maintenance  in  institutions  tends,  how- 
ever, to  lessen  the  number  of  patients  boarded  out. 

The  method  of  placing  the  insane  in  families  and  the 
supervision  exercised  by  the  General  Board  of  Lunacy 
over  those  boarded  out  was  thus  described  by  Commis- 
sioner Sibbald  : 

"  There  are  only  two  or  three  places  in  this  country  where 
you  can  see  a  considerable  aggregation  of  patients.  We  do  not 
consider  grouping  in  large  numbers  desirable,  but  prefer  that 
patients  should  be  scattered.  One  of  these  groups  is  at  Kennoway 
village  in  Fifeshire  ;  there  are  others  at  Balfron  and  Gartmore  in 
the  counties  of  Dumbarton  and  Perth.  At  Kennoway,  every 
thing  has  been  done  to  prevent  aggregation  increasing  ;  but  it 
has  increased  in  spite  of  our  efforts.  Each  family  is  examined 
as  to  its  suitability  for  the  reception  of  cases.  For  the  particular 
class  to  which  it  is  adapted  in  this  country,  the  system  works 
well.  The  Glasgow  parochial  authorities  are  among  those  who 
take  great  interest  in  the  boarding-out  of  pauper  lunatics. 
They  send  periodically  a  committee  of  their  number  for  inde- 
pendent paid  visitation,  and  take  a  personal  interest  in  the  condi- 
tion of  the  lunatics. 

"  Our  general  principle  is,  that,  as  far  as  possible,  we  should 
have  a  system  which  will  provide  for  each  case  according  to  its 
requirements.  If  a  person  requires  an  expensive  asylum — one 
with  elaborate  structural  arrangements,  and  where  a  great  deal  of 
attention  would  be  bestowed, — he  should  be  sent  there.  If  pa- 
tients are  fallen  into  a  condition  that  makes  them  easily  managed, 
and  if  they  do  not  require  very  special  arrangements,  but,  at  the 
same  time,  are  not  suitable  for  a  private  family,  we  try  to  place 
them  in  an  institution  where  their  wants  will  be  supplied.  Those 
who  do  not  come  under  either  category,  we  endeavor  to  find 
suitable  families  for.  As  a  rule,  patients  boarded  out  do  not 
include  acute  cases.  It  is  an  accident  if  such  a  case  is  included, 
or  it  is  when  the  family  are  the  natural  guardians  of  the  patient. 
For  instance,  a  man  is  taken  ill,  he  becomes  a  lunatic,  requires  to 
be  aided  from  public  sources,  and  must  be  attended  to.  His 
family  desire  our  permission  to  keep  him  in  a  private  house.  If 
the  case  promises  to  be  a  short  one,  he  is  not  sent  to  an  asylum, 


132  SCOTLAND. 

but  remains  with  his  friends.  Every  one  who  receives  public 
assistance  must  be  reported.  If  a  lunatic  is  boarded  in  a  family- 
other  than  his  own,  he  must  be  reported  ;  but  he  can  remain 
in  his  own  house  for  a  year,  if  he  does  not  require  special  con- 
trol. If  friends  require  to  exercise  control  to  deprive  him  of  or- 
dinary liberty,  they  can  do  so,  even  in  his  own  house,  only  for 
twelve  months  ;  thereafter  he  must  be  reported,  and  they  must 
submit  to  whatever  we  think  is  desirable.  Every  person  among 
the  insane  poor  who  is  boarded  out  is  visited  four  times  a  year  by 
the  medical  officer  of  the  parish,  and  twice  a  year  by  the  Inspector 
of  Poor  of  the  parish.  These  visits  are  all  recorded  in  a  book 
kept  by  the  person  to  whom  the  house  belongs,  and  in  the  record 
of  the  visit  there  is  practically  a  statement  including  several  de- 
tails ;  such  as,  that  the  patient  is  satisfactorily  provided  for  ;  that 
he  has  every  thing  he  requires  ;  and  that  the  conduct  of  the 
guardian  appears  to  be  suitable.  This  book  contains  the  six 
entries  every  year.  It  is  seen  by  our  Deputy  Commissioner  when 
he  makes  his  visit  ;  and  if  the  entries  are  not  made,  he  takes  note 
of  the  fact  and  reports  it.  We  immediately  inquire  into  the  rea- 
son, and  take  what  steps  seem  desirable  to  put  the  thing  right. 
Not  a  month  passes  but  some  one  has  to  be  taken  away  from 
a  family  because  of  improper  treatment.  When  we  hear  of  such 
cases  we  order  removal.  The  District  Lunacy  Board  has  noth- 
ing to  do  with  this  part  of  the  work.  We  deal  directly  with  the 
parish  that  makes  application  to  us  through  its  officers." 

The  correspondence  of  the  Board  in  connection  with  this 
branch  of  the  work  is  very  voluminous.  Each  case  is  ex- 
amined into  with  great  thoroughness,  and  the  reports  and 
papers  relating  thereto  are  separately  filed.  It  appeared 
from  the  records  that,  in  some  cases,  as  many  as  six  letters  a 
month  had  been  written.  In  one  instance,  the  correspond- 
ence extended  through  a  period  of  seven  years ;  in  another 
case,  that  of  a  boarded-out  female,  through  fifteen  years. 
Our  informant   continued  : 

''These  reports  the  Deputy  Commissioner  takes  with  him  in 
going  his  rounds  over  the  country,  and  they  supply  him  with 
a  history  of  each  case.     Some  he  does  not  deem  it  necessary  to 


BOARDING-  OUT.  1 3  3 

visit  frequently.  They  are  people  who  are  known  to  enjoy  a 
considerable  amount  of  liberty  and  who  live  in  comfortable  cir- 
cumstances— where  there  is  absolute  certainty  that  the  patient  is 
comfortable  and  well  treated  without  being  subject  to  unnecessary 
control.  It  may  be  one  living  much  in  the  gaze  of  the  public, 
about  whom  there  is  no  doubt.  In  such  a  case,  we  do  not  say, 
'  You  are  a  lunatic,  and  I  come  to  inspect  you.'  It  does  not  rest 
with  the  Deputy  Commissioner,  however,  to  leave  off  visiting. 
The  case  must  be  reported  here,  and  we  may  approve  or  disap- 
prove of  the  doctor's  proposal  to  discontinue  visits.  Frequent 
visitations  are  made  in  unsatisfactory  cases  ;  but  we  desire  to 
avoid  '  red-tape  '  in  carrying  out  our  arrangements.  We  strive  to 
have  good  reason  for  whatever  we  do — to  have  matters  properly 
considered,  and  to  avoid  negligent  conclusions." 

The  great  pressure  on  asylum  accommodation  and  the  in- 
ducements offered  by  the  lower  charge  for  support  in  fami- 
lies doubtless  have  much  to  do  with  the  extension  of  the 
boarding-out  system  in  Scotland.  The  price  paid  for  the 
maintenance  of  paupers  boarded  out  is  not  uniform,  but  de- 
pends on  the  locality  and  its  proximity  to  a  market.  In 
justification  of  the  extremely  low  rates  paid  in  some  locali- 
ties, one  of  the  Deputy  Commissioners  says  : 

"The  Shetland  guardian,  who  undertakes  to  maintain  an  un- 
productive lunatic  at  the  rate  of  2s."  (say  50  cents)  "  per  week, 
may,  at  first  sight,  seem  to  be  badly  treated,  as  compared  with 
the  Lanark  guardian,  to  whom  Sj-.  per  week  is  paid  for  the  main- 
tenance of  a  similar  patient.  When,  however,  it  is  considered 
that  in  the  latter  county  every  article  supplied  for  the  use  of  the 
patient  is  a  readily  marketable  article,  procurable  only  by 
exchange  for  money  or  marketable  labor,  and  that  in  the  former 
the  habits  of  the  people  and  the  abundant  supply  of  fish  for  food, 
render  it  almost  unnecessary  for  the  careful  guardian  to  expend 
the  allowance  in  any  thing  but  luxuries,  the  difference  is  seen  to 
be  only  an  apparent  one.  Similarly  the  standard  of  comfort 
varies  as  much  between  several  of  the  counties  as  if  they  were 
situated  in  entirely  different  countries.  In  estimating,  therefore, 
whether  proper  provision  has  been  made  for  the  comfort  of  an 


134  SCOTLAND. 

insane  patient  boarded  in  a  private  dwelling,  it  is  necessary  to 
employ  not  a  national,  but  a  local  standard,  to  determine  whether 
a  lunatic  is  treated  well  as  compared  with  other  members  of 
society  of  the  same  rank  inhabiting  the  same  district." 

As  much  interest  attaches  to  the  boarding-out  system,  a 
personal  inspection  was  made  of  a  considerable  number  of 
the  cottages  in  which  the  insane  are  received,  and  it  may 
not  be  out  of  place  to  describe  briefly  the  homes  and  sur- 
roundings of  some  of  those  intrusted  to  family  care.  Ken- 
noway,  a  small  village  near  the  Fifeshire  coast,  was  the  first 
place  visited.  It  commands  a  pleasing  view  over  the  Firth 
of  Forth,  though  distant  about  three  miles  from  the  sea. 
The  narrow  and  irregular  streets  and  the  antiquated  look  of 
some  of  the  one  and  two  story  houses  ranged  on  either  side 
proclaim  the  primitive  character  of  the  place.  Here,  as  in 
most  of  the  country  villages  of  Scotland,  surface  drainage 
prevails.  Some  of  the  dwellings  have  tile  and  others 
thatched  roofs  ;  and,  although  a  fair  degree  of  cleanliness  is 
maintained,  there  are  evidences  on  every  hand  that  the  in- 
habitants arc  unambitious,  there  being  little  scope  for  enter- 
prise. They  have,  apparently,  succumbed  to  the  inevitable  and 
quietly  settled  down  to  their  cramped  surroundings.  Trade, 
which  consists  largely  of  hand-loom  weaving,  has  been  on 
the  wane  for  years, — a  circumstance  which  tends  to  explain 
the  decrease  of  population  and  the  moderate  rental  of  the 
houses.  Several  rent  small  patches  of  ground  ;  and,  besides 
the  few  trades-people  and  small  shopkeepers  necessary  to  meet 
the  limited  requirements  of  the  place,  there  arc  resident  in 
the  village,  the  clergyman  of  the  parish,  a  medical  man,  a 
schoolmaster,  and  an  inspector  of  poor.  Sheltered  by  heath- 
clad  hills  from  the  cold  north  wind,  and  secluded,  though  not 
distant  from  the  larger  centres  of  population,  Kcnnoway 
has  apparently  been  well  chosen  as  a  settlement  for  the  in- 


BOARDING-OUT.  I35 

sane.     And  now  let  us  glance  at  the  interior  of  some  of  its 
cottages  as  described  in  my  notes. 

(a)  Here,  in  a  one-story  cottage,  plainly  built  of  stone,  and 
having  a  red  tile  roof,  reside  an  aged  married  couple — the  husband 
very  deaf.  The  wife,  it  must  be  confessed,  is  not  over  cleanly  in 
appearance.  The  boarders  are  two  female  lunatics,  one  of  whom 
is  abed,  and  the  other  walking  about  in  her  room,  which  is  of 
goodly  size  and  has  an  open  fire-place.  On  the  papered  walls  are 
a  few  pictures,  and  the  furniture  comprises  a  wooden  table  and 
one  or  two  chairs.  The  other  and  better  furnished  apartment 
occupied  by  the  first-mentioned  patient  contains  abed  in  a  recess, 
an  inclosed  closet,  an  open  grate,  a  carpet  on  the  floor,  and 
mahogany  chairs  with  hair  bottoms.  Each  boarder  is  received 
at  six  shillings  per  week.  The  housewife,  referring  to  the  patients, 
says  :  "  They  gie  verra  little  trouble,  troke  aboot,  and  are  able  to 
dae  ony  little  thing  for  themsels." 

{1))  This  is  an  antiquated  two-story-and-garret  stone  cottage  with 
red  tile  roof.  It  is  occupied  by  a  widow  who  boards  four  female 
patients.  One  of  these  is  subject  to  epileptic  fits,  and  keeps  her 
bed.  The  other,  a  woman  nearly  fifty-three  years  of  age,  has 
been  here  about  seventeen  years.  She  takes  her  meals  in  the 
kitchen,  which  is  of  fair  size,  and  has  a  red  brick  floor  and  an  open 
fire-place.  In  the  four  other  apartments  are  open  fire-places, 
carpeted  floors,  hair-bottomed  mahogany  chairs,  and  close- 
curtained  wooden  bedsteads.  Among  other  objects  seen  are 
flowers  and  dried  grasses,  pictures  on  the  walls.  Scriptural  mot- 
toes, etc.  One  of  the  patients  says  :  "  The  mistress  is  verra  kind 
to  ilka  body  i'  the  house,  an'  we  help  her  to  keep  it  in  good 
order."  Each  of  the  patients  is  paid  for  by  the  parochial  board 
at  the  rate  of  (ys.  per  week. 

The  buildings,  though  in  good  repair,  are  many  of  them 
old  and  quaint-looking.  The  one  last  mentioned  has  corbie- 
stepped  gables,  and  above  the  doorway  is  a  stone  panel  with 
a  coat-of-arms  in  has  r^/zV/"  surmounted  by  a  crown  and  bear- 
ing date  1712. 

(^)  In  this  two-story  stone  building,  which  is  occupied  by  a 
widow,  there  are  boarded  four  female  patients.     Two  of  these 


136  SCOTLAND. 

occupy  separate  sleeping-rooms  up-stairs,  and  the  other  two,  wha 
are  from  the  Edinburgh  asylum,  have  a  room  on  the  lower  floor, 
in  which  are  two  beds.  The  latter  are  upwards  of  fifty  years  of 
age,  and  they  occasionally  promenade  about  the  large  garden  in 
the  rear  of  the  house  or  along  the  not-much-frequented  roadway 
in  front.  One  of  them  has  a  disposition  to  work.  Open  fire- 
places are  used,  and  there  is  an  appearance  of  cleanliness  and  a 
fair  share  of  comfort.  The  patients  living  up-stairs  have  their 
meals  separately  conveyed  to  their  rooms.  They  have  oatmeal 
porridge  in  the  morning,  beef  broth  with  potatoes  for  dinner,  and 
tea  at  night.  The  housewife  assures  us,  "  They  're  a'  very  easy 
tae  pit  up  wi'." 

(^)  The  tenant  of  this  house  is  a  contractor,  who  owns  a  pair 
of  horses  and  a  couple  of  carts.  Two  male  patients  are  boarded 
here,  one  sixty  and  the  other  forty-five  years  of  age.  They  sleep 
in  separate  beds  in  a  room  up-stairs  with  low  ceiling.  It  meas- 
ures 17  X  18  feet,  and  has  an  open  fire-place.  The  furnishing  is 
plain,  but  seemingly  comfortable.  The  patients  dine  in  the 
kitchen  with  the  contractor  and  his  wife.  Breakfast  at  8  a.m. 
consists  of  porridge  and  milk  ;  dinner  between  12  and  i  p.m.,  of 
broth  with  beef  or  home-cured  pork  ;  at  6  p.m.  tea  is  served  with 
bread  and  butter  ;  about  9  p.m.  bread  and  milk.  On  certain  days, 
for  dinner,  rice  and  milk  with  bread  and  potatoes  is  substituted 
for  broth.  One  of  the  boarders  has  been  five  years  in  this  house 
and  is  spoken  of  as  "  a  handy  sort  o'  bodie,  who  gies  verra  little 
trouble  and  does  what  he  's  bidden."  The  patients  are  paid  for 
at  the  rate  of  ()s.  6d.  each  per  week.  They  find  plenty  of  exercise 
in  the  garden,  and  are  said  to  manifest  no  disposition  "  to  rin 
awa,'  bit  jist  paidle  aboot  the  street." 

{e)  This  is  a  one-story  cottage  with  red  tile  roof.  A  parapet 
wall  with  iron  top-railing  and  two  iron  gates  encloses  the  front 
plot  of  ground,  which  is  made  attractive  with  shrubs,  fuchsias, 
climbing  roses,  and  other  flowers.  In  this  clean  and  tidy  dwell- 
ing, tenanted  by  an  aged  married  couple — the  mistress  being 
about  seventy — are  three  snug-looking  apartments.  The  two 
female  patients  occupy  separate  beds  in  a  parlor,  where  an  open 
fire  burns  brightly.  The  bedding  is  comfortable,  and  the  old- 
fashioned  wooden  bedsteads  are  curtained.  One  of  the  patients 
has  been  here  nine  and  the  other  seven  years.  The  latter,  nearly 
seventy  years  old,  takes  her  breakfast  in  bed.     Says  the  house- 


BOA  RDING-  OUT.  1 3  7 

wife  :  "  The  tither  ane  gets  up  and  scrubs  the  floor  and  carries 
water  frae  the  well."  The  worker  thus  referred  to  is  about 
fifty  years  of  age.  Their  washing,  the  aged  landlady  says,  is 
given  out. 

(_/)  In  a  one-story  cottage  of  two  apartments,  tenanted  by  a 
maiden  lady,  are  two  patients,  one  of  whom  is  an  old  woman  who 
has  boarded  here  for  the  last  eighteen  years.  The  landlady,  a 
weakly  person  and  in  humble  circumstances,  keeps  a  female  ser- 
vant to  do  the  housework.  The  interior  is  not  over  cleanly, 
though  the  patients'  room  seems  rather  tidier  than  the  rest  of  the 
house.  The  elderly  patient  sleeps  in  a  bed  occupying  a  recess 
in  the  wall.  The  furnishing  is  fair.  The  patients  receive  their 
meals  together  in  the  kitchen.  One  of  them  informs  us  that  she 
is  "  quite  comfortable  an'  has  jist  to  gae  oot  an'  tak'  a  walk  doon 
the  lane  when  she  likit." 

The  patients  living  under  family  care  are,  as  has  been 
stated,  distributed  over  all  the  counties  in  Scotland,  and 
efforts  are  made,  as  far  as  possible,  to  prevent  any  aggrega- 
tion in  localities.  Quiet  rural  districts,  however,  afford 
peculiar  facilities  for  boarding  the  insane,  and  where  such 
places  are  peopled  by  sober  and  industrious  peasants  in 
humble  circumstances,  willing  to  receive,  at  a  low  rate, 
patients  of  docile  character,  it  is  not  always  easy  to  prevent 
undue  accumulation.  The  counties  in  Scotland  containing 
the  largest  numbers  of  patients  in  private  dwellings  are 
Fife,  Perth,  Edinburgh,  and  Lanark ;  where  it  is  to  the 
advantage  of  the  small  farmer  to  board  one  or  two  of  this 
class.  Many  are  accommodated  and  their  labor  utilized 
among  the  crofters  of  Orkney,  Shetland,  and  other  sparsely 
populated  districts,  where  ■  provisions  are  cheaply  raised, 
and  where  even  the  meagre  allowance  of  the  parochial 
authorities  is  an  inducement.  Without  wear\'ing  the  reader 
by  recounting  cases  in  which  the  details  arc  similar  in  char- 
acter, onl}-  two  more  illustrations  of  family  care  will  be  given, 
as  witnessed  in  one  of  the  more  remote  of  these  rural  dis- 


138  SCOTLAND. 

tricts.     The  following  are  taken  at  random  from  the  notes 
made  : 

{a)  In  a  plain,  two-story,  tile-roofed  house,  are  two  male 
lunatics,  one  of  whom,  named  Peter,  is  subject  to  epileptic  fits. 
He  has  been  here  seven  years.  The  guardian  informs  us  that  the 
fits  to  which  he  is  subject  come  on  at  intervals  of  a  fortnight,  and 
that  the  patient  is  allowed  to  go  about  until  the  attacks  abate. 
He  is  described  as  a  hard  smoker,  and  when  disposed  to  consume 
too  much  tobacco,  a  portion  is  withheld.  This  invariably  enrages 
him  ;  but,  as  the  guardian  remarks,  "  He  soon  calms  doon  again." 
Charlie,  the  other,  has  been  in  this  house  for  about  twelve  years, 
and  was  formerly  boarded  with  the  father  of  his  present  host. 
Neither  of  the  patients  ever  tried  to  run  away.  Both  sleep  in  a 
good-sized  back  bedroom,  in  which  are  separate  iron  bedsteads, 
with  bedding  clean  and  comfortable.  One  of  the  sheets  has  been 
torn  somewhat  by  Peter,  and  he  is  reported  as  sometimes  at- 
tempting to  destroy  his  clothing.  On  the  wooden  mantel  are 
flower  vases  with  dried  grasses  and  numerous  little  ornaments  ; 
on  the  papered  walls  are  pictures,  including  a  large  portrait  of 
the  great  poor-law  reformer  and  eminent  divine,  Ur.  Chalmers. 
In  the  plainly  furnished  kitchen,  a  grate  fire  with  open  range 
sends  forth  a  ruddy  glow.  On  the  upper  floor  is  a  front  room 
ready  for  other  patients.  It  is  furnished  with  Brussels  carpet, 
stuffed-bottom  mahogany  chairs,  a  book-case,  and  a  large  double, 
iron  bedstead  with  a  brass  top-rail.  There  are  two-sash  windows 
with  Venetian  blinds.  The  stairs  leading  to  this  comfortable 
apartment  are  of  varnished  pitch  pine,  on  which  is  laid  a  strip  of 
colored  oil-cloth.  The  patients  take  their  meals  with  the  family 
in  the  kitchen. 

((5)  Here,  in  a  low,  plain  stone  cottage  with  red  tile  roof,  an 
elderly  widow  retains  as  boarders  two  adult  female  pauper  luna- 
tics, who  have  been  in  the  house  about  five  years  ;  also  a  sane  girl 
about  ten  years  old,  but  boarded  out  by  the  poor-law  authorities 
for  the  past  four  years.  The  little  girl  is  out  on  a  ''  berrying  " 
excursion  with  other  children  of  the  place.  Another  of  the  in- 
mates is  a  sane  blind  woman,  who  has  been  boarded  out  by  the 
poor-law  authorities  for  the  past  six  years.  The  kitchen  pave- 
ment laid  with  concrete  cement  and  the  parlor  floor  of  wood 
are  clean.       The   furniture  is  plain,  but   tolerably  comfortable. 


A    DEPUTY  COMMISSIONER'S    VIEWS.  1 39 

The  space  within  this  small  one-story  cottage  seems  insuffi- 
cient for  the  requirements  of  the  inmates.  It  is  a  matter  of  sur- 
prise that  so  many  dependents  differing  so  materially  in  their 
mental  and  physical  conditions  should  receive  common  care 
under  the  same  cottage  roof. 

Dr.  Fraser,  Deputy  Commissioner,  whose  visitations 
during  1884  extended  to  1,073  patients  in  private  dwellings, 
says : 

"  Every  year  there  is  in  my  experience  a  manifest  change  for 
the  better  in  the  condition  of  the  insane  provided  for  in  private 
dwellings.  Any  thing  like  retrogression  in  the  condition  of  a 
patient  so  provided  for  stirs  up  active  interference,  the  end  of 
which,  if  the  Board  fail  to  bring  back  a  satisfactory  condition, 
may  be  a  resort  to  asylum  care  and  treatment.  There  is,  and  I 
fear  there  always  will  be,  a  small  number  of  the  boarded-out 
insane,  chiefly  under  the  care  of  persons  bound  to  them  by  ties  of 
kinship,  whose  condition  cannot  be  regarded  as  satisfactory.  In 
these  cases  the  condition  in  which  the  guardians  live  is  some- 
times far  from  being  what  is  desirable,  especially  as  regards 
cleanliness  and  comfort  ;  but  when  there  is  a  kindly  treatment 
founded  on  natural  affection,  it  is  often  thought  well  not  to  insist 
on  the  separation  of  parents  and  children,  or  brothers  and  sisters, 
though  there  may  be  a  slovenliness  and  want  of  cleanliness  in 
the  surroundings  of  the  family  which  is  greatly  regretted,  and 
which  may  be  found  to  exist  in  neighboring  houses  occupied  by 
poor  rate-payers. 

"As  regards  the  great  majority  of  the  insane  in  private  dwell- 
ings in  my  district,  I  have  not  the  least  hesitation  in  saying  that 
they  are  adequately  and  suitably  provided  for  ;  that  their  general 
condition  is  a  satisfactory  one  ;  that  they  enjoy  a  more  rational, 
normal,  and  healthy  life  than  any  institution  could  afford  them  ; 
that  they  are  satisfied  with  the  arrangements  made  for  their  care 
and  comfort ;  and  that  they  would  not  exchange  their  domestic 
and  other  privileges  for  any  other  treatment  of  which  they  may 
have  had  experience.  The  evidence  of  the  correctness  of  these 
views  lies  in  the  low  mortality  which  exists  among  the  boarded- 
out  insane,  their  good  health  and  good  physical  condition,  the 
rarity  of  accidents  among  them,  and  their  general  contentment." 


I40  SCOTLAND. 

Respecting  the  adoption  of  the  system  elsewhere,  the 
Deputy  Commissioner  gives  it  as  his  opinion  that  Scotland 
has  no  special  advantages  for  the  treatment  of  the  insane  in 
private  dwellings,  but  that  "  other  countries  possess  retired 
hamlets  and  villages,  clean  and  tidy  cottages,  and  thrifty, 
respectable,  and  matronly  housewives,  who  would  make  ex- 
cellent nurses  for  the  insane.  The  system  has  been  firmly 
established  in  Scotland,  and  is  growing  there,  mainly,  if 
not  entirely,  because  there  is  faith  in  it,  and  earnest  efforts 
have  been  made  to  render  its  working  satisfactory." 

Deputy  Commissioner  Lawson,  whose  visitations  in  1884 
extended  to  879  boarded-out  patients,  divides  the  pauper 
patients  visited  into  four  classes. 

"  In  each  house,  and  with  the  patient  before  me,  I  have 
recorded  in  my  visitation  book  my  impression  of  the  satisfactori- 
ness  or  unsatisfactoriness  of  his  care  and  guardianship.  In  doing 
so  I  divided  my  patients  into  four  classes,  under  headings  indi- 
cating the  nature  of  the  provision  made  for  them,  namely,  Bad, 
Middling,  Good,  and  Very  Good.  Of  course  it  is  impossible  to 
insist,  in  localities  so  diverse  in  their  notions  of  social  comfort  as 
are  the  counties  embraced  in  my  district,  on  a  uniform  standard 
of  excellence.  We  must  regard  lunatics,  whether  in  Shetland  or 
in  Roxburghshire,  as  being  under  '  Good  '  conditions  who  are  as 
well  provided  for  as  sane  people  in  the  same  rank  of  life  in  their 
neighborhood.  Under  the  heading  of  '  Very  Good  '  I  embrace 
cases  in  which  the  amount  of  care  bestowed  on  the  patients  and 
comfort  enjoyed  by  them  are  conspicuously  superior  to  what 
their  surroundings  would  have  led  one  to  expect.  Under  the 
term  '  Middling '  are  grouped  patients  who,  though  on  the  whole 
sufficiently  well  provided  for,  are  neither  in  themselves  nor  in 
their  surroundings  so  comfortable  as  similar  patients  in  the 
same  district.  They  make  up  the  class  in  which  advice  and  ex- 
postulation are  needed,  and  are  generally  effective.  Under  the 
heading  '  Bad  '  I  include  patients  so  unfavorably  situated  that  an 
immediate  change  of  guardianship  would,  apart  from  other  con- 
ditions, be  considered  advisable." 


POLICY  OF   THE   BOARD.  I4I 

In  summing  up,  Deputy  Commissioner  Lawson  finds  the 
condition  of  24.3  per  cent  very  good,  60.6  good,  12.2  per 
cent  middling,  2.9  per  cent  bad. 

Of  6"]  non-pauper  patients  in  private  dwellings  visited,  the 
same  official  reports  that  he  "  found  them,  without  exception, 
suitably  provided  for,  and  in  a  manner  in  keeping  with  their 
resources.  Many  of  them  are  so  completely  integrated  with 
the  families,  whether  related  or  unrelated,  in  which  they 
live,  that  visitation  is  more  or  less  formal.  In  the  houses 
specially  licensed  for  receiving  a  limited  number  of  private 
patients  and  boarders,  I  found  the  inmates  and  lodgers 
satisfied  and  comfortable." 

The  Scotch  Lunacy  Board  defines  its  policy  in  respect  to 
the  boarding-out  system  as  follows  : 

"  It  is  sufficient  to  say  that  the  policy  of  the  Board,  of  which 
the  boarding-out  has  been  an  outcome,  has  been  to  discourage 
the  unnecessary  or  needlessly  prolonged  removal  of  pauper 
lunatics  from  the  position  which  they  would  naturally  have  oc- 
cupied if  they  had  been  sane  ;  and  where  such  removal  is  re- 
quired, either  for  their  own  welfare  or  the  public  interest,  to  prevent 
the  restrictions  and  other  circumstances  of  their  treatment  from 
interfering  more  than  is  necessary  with  their  natural  mode  of  life. 
With  this  view  we  have  striven  to  prevent  the  unnecessary  or 
inconsiderate  removal  of  patients  from  their  own  homes,  to 
encourage  as  far  as  possible  the  abatement  of  the  prison  features 
of  asylums,  and  to  stimulate  the  relegation  of  patients  from 
asylums  to  their  homes  when  asylum  treatment  ceased  to  be 
beneficial.  In  accordance  with  this,  we  have  encouraged  the 
transference  of  patients  in  asylums  for  whom  asylum  treatment 
had  become  unnecessary  to  the  houses  of  strangers  in  their  own 
position  in  life,  but  only  when  no  relatives  could  be  found  able 
and  willing  to  take  efficient  care  of  them.  In  this  way  the 
boarding-out  has  had  the  effect  of  diminishing  the  demand  for 
further  asylum  accommodation,  and  has  permitted  a  considerable 
number  of  pauper  lunatics  to  live  in  a  way  little  removed  in  its 
character  from  the  mode  of  life  which  they  would  have  led  had 
they  not  suffered  from  insanity." 


142  SCOTLAND. 

A  considerable  number  of  institutions  for  the  insane  were 
examined  in  Scotland,  but  descriptions  of  only  one  each  of 
several  different  types  of  asylums  are  here  given. 

THE   BARONY   PAROCHIAL   ASYLUM,    WOODILEE,    LENZIE. 

This  asylum  is  managed  by  an  unpaid  committee  of 
the  local  Poor-law  Board  of  the  Barony  parish  of  Glas- 
gow. It  accommodates  upwards  of  five  hundred  patients, 
mostly  from  the  city,  a  large  proportion  of  whom  are  the 
acute,  suicidal,  and  dangerous.  The  Barony  parish  was  the 
first  in  Scotland  to  avail  itself,  in  1875,  of  the  powers  of  the 
Act  already  referred  to,  enabling  poor-law  authorities  who 
had  already  provided  accommodation  for  their  insane,  to 
continue  to  do  so  under  license  of  the  Commissioners  in 
Lunacy  without  interference  from  the  district  boards.  That 
enactment  is  now  popularly  known  in  Scotland  as  the  Lenzie 
Act.  Under  the  powers  thus  conferred  upon  them,  the 
Barony  parochial  authorities  erected,  at  a  cost  of  about  ^300 
per  bed,  one  of  the  best  pauper  asylums  in  Great  Britain. 
It  occupies  a  healthful  and  pleasant  country  site,  ten  miles 
distant  from  Glasgow  and  three  fourths  of  a  mile  from 
Lenzie.  It  has  attracted  much  attention  on  account  of  the 
amount  of  liberty  extended  to  the  patients,  the  absence  of 
locked  doors  and  all  kinds  of  walled  enclosures,  and  the 
substitution  of  well-directed  employments  for  mechanical  or 
chemical  restraint. 

There  are  three  hundred  and  eighty-two  acres  of  land 
belonging  to  the  asylum.  Twenty  acres  are  reserved  for 
exercise  and  recreation  ;  the  remainder,  as  also  some  leased 
land,  making  in  all  upwards  of  four  hundred  and  fifty 
acres,  is  worked  under  a  thorough  agricultural  system,  and 
affords  outdoor  employment  to  a  large  number  of  the 
insane.  A  considerable  number  of  working  patients  occupy 
detached  dwellings  on  the  farm  lands. 


WOOD/LEE. 


143 


At  the  entrance  to  the  asylum  is  a  neat  porter's  lodge 
occupied  by  a  married  attendant  and  several  patients.  The 
asylum  buildings,  which  are  of  two  stories,  are  artistically 
designed  and  advantageously  disposed.  The  grounds  are 
tastefully  ornamented  with  shrubbery  and  flowers.  Nothing 
in  the  semblance  of  wall  or  enclosure  meets  the  eye,  if  we 
except  an  iron  fence  at  a  distance  of  ninety  yards  from  the 
main  building,  and  bordering  the  Edinburgh  and  Glasgow 
Railway.  This  road  extends  three  quarters  of  a  mile  through 
the  asylum  grounds,  and  nearly  two  hundred  trains  pass 
over  it  daily. 

The  asylum  officers  consist  of  a  medical  superintendent 
and  assistant,  a  chaplain,  clerk  to  committee,  house  clerk 
and  steward,  assistant  steward,  matron  and  assistant  matron. 
There  is  one  attendant  to  ten  patients.  The  male  and  female 
sides  of  the  building  are  each  divided  into  four  distinct  sec- 
tions. Each  section  contains  about  sixty  beds,  and  is  in 
charge  of  a  chief  attendant,  under  whom  are  three  subor- 
dinates. At  the  time  of  my  visit,  there  were  in  all  476 
inmates — 241  men  and  235  women. 

The  lower  story  of  the  asylum  building  is  set  apart  for 
day  use;  the  upper,  for  night  occupation.  In  the  dormito- 
ries, the  uncarpeted  polished  pine  floors  have  an  appearance 
approaching  elegance.  The  polish  is  imparted  by  using  a 
compound  of  beeswax  and  turpentine,  which  is  applied  with 
a  soft  cloth  fastened  on  a  weighted  blocJ<:.  The  work  of 
polishing  is  done  by  patients  who  cannot  otherwise  be  well 
employed.  The  walls  are  tinted  and  adorned  with  pictures. 
The  air  is  made  fresh  and  pure  by  opening  the  windows  as 
soon  as  the  rooms  are  vacated  by  the  patients.  By  means 
of  two  large  open  coal  fires  the  dormitories  are  heated  and 
ventilation  is  promoted.  The  windows  of  the  upper  apart- 
ments have  neither  iron  sashes  nor  outer  guards.     This  ar- 


144  SCOTLAND. 

rangement,  approved  by  Dr.  Rutherford,  the  superintendent, 
forms  part  of  the  free  system  obtaining  throughout  the  in- 
stitution. For  some  of  the  single  rooms,  sliding  shutters 
are  used.  As  was  found  elsewhere  in  Scotland,  the  beds 
were  comfortable  and  bed-clothing  abundant.  Each  bed  was 
furnished  with  a  palliasse,  hair  mattress,  two  pairs  of  heavy 
blankets,  sheets  and  coverlet,  hair  bolster,  and  feather 
pillows.  The  bedding  is  carefully  attended  to,  and  the 
sheets  and  blankets  for  each  division  have  a  distinguishing 
stripe.  The  strong  wooden  bedsteads  have  elastic  slats  and 
substantial  head  and  foot  boards.  They  are  taken  to  pieces 
for  renovation  once  a  fortnight.  The  associated  dormitories 
have  each  two  small  bureaus  and  chests  of  drawers,  a  double 
breadth  of  three-ply  carpet  in  the  centre  of  the  room,  a  rug 
by  the  side  of  each  bed,  besides  minor  articles  which  add  to 
the  comfort  and  cheerful  appearance  of  the  room.  Each 
associated  dormitory  has  eleven  beds. 

In  the  fourth  division  there  are  eight  single  rooms.  Al- 
together there  are  in  the  institution  one  hundred  and  four- 
teen single  apartments.  Two  strong  rooms  on  either  side 
have  double  doors,  and  windows  effectually  protected  by 
sliding  wooden  blinds. 

The  infirmary  wards  are  even  more  liberally  furnished  than 
the  other  apartments.  The  furniture  includes  Brussels  car- 
pets, easy  and  invalid  mahogany  chairs,  centre  tables,  book- 
cases, etc.  In  the  rooms  for  convalescent  patients,  the  win- 
dows have  ordinary  wooden  sash,  the  panes  measuring  lox  i6 
inches.  Epileptics  are  separately  cared  for  and  closely  super- 
vised in  the  infirmary  department.  Here  are  large  un- 
screened open  fire-places.  This  department  has  an  attract- 
ive aviary,  in  which  the  patients  seemed  much  interested. 
Suicidal  patients  are  assigned  to  the  various  wards,  and 
over  them  a  special  watch  is  maintained. 


WOODILEE. 


145 


The  bath-rooms  are  conveniently  arranged,  and  furnished 
with  mirrors,  combs,  brushes,  etc.  Water  is  pumped  to 
reservoirs  in  the  towers  of  the  building,  whence  it  flows 
to  every  part  of  the  establishment.  A  dial  on  the  lower 
floor  indicates  the  quantity  of  water  stored. 

Two  sewing  or  day  rooms  that  I  entered  on  the  ground- 
floor  are  likewise  cheerful  and  well-furnished  apartments, 
each  having  a  work-table,  piano,  comfortable  lounges,  flower 
vases,  and  other  articles  of  use  and  decoration.  The  open 
fire-places  are  made  more  attractive  by  bright-colored  tiles. 
Pleasing  outlooks  are  obtained  from  the  wide  bay-windows. 
A  considerable  number  of  women  patients  were  here  at  work, 
apparently  contented  and  happy. 

There  is  a  large,  tastefully  decorated  hall  with  raised  plat- 
form on  which  was  a  piano.  The  hall  is  appropriately  fur- 
nished and  is  used  for  entertainments,  including  weekly 
dances,  which  are  exceedingly  popular  with  the  inmates. 
A  band  composed  of  attendants  and  patients  plays  every 
Saturday  afternoon,  either  in  the  hall  or  out-of-doors,  ac- 
cording to  the  weather.  The  asylum  is  well  supplied  with 
reading  matter,  consisting  of  books  and  cheap  publications. 

In  the  dining-hall  I  saw  about  225  men  and  nearly  as  many 
women  at  dinner.  The  tables,  covered  with  snow-white 
linen,  were  ranged  in  three  rows  or  divisions.  There  were 
chairs  for  eight  persons  at  each  table.  On  one  side  of  the 
hall  were  the  men,  and  on  the  opposite  side,  the  women  ; 
while  the  intermediate  centre  space  was  occupied  by  the  at- 
tendants. The  table  furnishing,  except  for  the  suicidal,  em- 
braced a  variety  of  articles,  including  casters,  water-bottles, 
ordinary  spoons,  knives  and  forks,  soup  and  dinner  plates, 
bright  metallic  soup  ladles,  tureens,  and  salt-cellars.  Each 
patient  was  provided  with  a  table  napkin.  The  meal  com- 
prised Scotch  broth  and  dumplings,  with  meat  and  a  plcnti- 


146  SCOTLAND. 

ful  supply  of  vegetables  and  other  nourishing  food.  Half 
an  hour  is  allowed  for  the  patients' dinner ;  then  follows  that 
of  the  attendants,  which  is  partaken  of  in  the  presence  of 
the  patients  and  while  they  remain  sitting  at  table.  Both 
have  the  same  kind  of  food,  except  on  two  days  of  the  week, 
when  the  attendants  have  soup  and  fish  for  dinner.  The 
insane  are  not  permitted  to  carry  food  from  the  table,  and 
care  is  taken  to  remove  all  the  dishes  and  knives  and  forks 
before  they  leave.  The  windows  of  the  capacious  dining- 
room  are  large,  and  have  single  panes  to  each  sash.  It  was 
stated  that  but  one  of  these  had  ever  been  broken  by  the 
inmates.  The  superintendent  said  he  preferred  bringing  as 
many  of  the  insane  as  possible  into  the  dining-hall ;  for,  he 
added  :  "  The  most  diflficult  as  well  as  the  most  important 
part  of  asylum  work  is  for  the  attendant  to  learn  the  pe- 
culiarities of  his  patients."  The  sick,  however,  as  well  as 
those  who  cannot  be  trusted  in  the  dining-hall,  have  their 
meals  carried  to  them.  Epileptics  dine  with  the  other  in- 
mates.    Two  had  attacks  of  epilepsy  during  the  meal. 

The  kitchen  is  of  one  story,  and  has  a  large  central  hood 
or  funnel  for  carrying  off  the  steam  from  the  food  while 
cooking.  Thirty  brightly  polished  tea  and  coffee  urns  were 
observed  in  their  appropriate  places.  The  floor  was  of  tile, 
enhancing  the  neat  appearance  of  the  apartment,  which, 
with  the  store-room  adjoining,  was  orderly  arranged  and 
carefully  kept.  Throughout  the  asylum,  every  article  of 
brass  or  steel,  including  knobs,  faucets,  and  spittoons,  was 
burnished.  In  the  halls  and  corridors  were  laid  breadths  of 
linoleum  with  bright  colored  borders. 

Dr.  Rutherford,  as  already  intimated,  is  one  of  the  fore- 
most advocates  of  non-restraint,  and  also  of  healthful  exer- 
cise and  employment.  It  was  stated  that  there  were  no 
strait-jackets    nor    restraining    dresses  —  nothing    involving 


WOODILEE.  147 

mechanical  restraint  within  the  institution.  If  violent,  a 
patient  is  walked  about  until  he  calms  down  ;  and  if  very 
^violent,  he  is  placed  in  charge  of  two  or  more  special  attend- 
ants. Notwithstanding  the  freedom  allowed,  few  escape 
who  are  not  brought  back  the  same  day. 

No  fewer  than  one  hundred  and  forty-eight  men  were  em- 
ployed on  the  farm  and  grounds.  In  very  wet  weather, 
these  men  are  placed  at  work  under  shelter,  but  a  slight 
shower  of  rain  is  not  deemed  hurtful.  Patches  of  ground 
alike  in  size,  and  an  equal  number  of  patients  are  assigned 
to  each  of  the  different  attendants  working  in  the  extensive 
gardens,  who  are  thus  stimulated  to  compete  for  the  largest 
product.  The  ground  for  vegetables  is  cultivated  chiefly 
with  the  spade.  In  managing  the  laboring  force,  some  tact 
appeared  to  be  exercised.  As  we  approached  the  stone- 
quarry  where  a  small  group  were  employed,  an  Irishman 
sprang  upon  a  mound  of  earth  and  broke  into  loud  speech, 
accompanied  by  violent  gesticulation.  No  one  paying  the 
slightest  attention  to  him,  he  soon  took  up  his  tools  and  went 
to  work.  Seventeen  men  were  occupied  as  mechanics  in  the 
different  workshops  for  various  crafts,  including  shoemak- 
ing,  carpentering,  tailoring,  tinsmith  work,  gas-fitting,  and 
blacksmith  work.  About  forty  weakly  patients  and  epilep- 
tics were  excluded  from  the  working  groups.  All,  however, 
not  unfit  to  labor,  are  obliged  to  go  with  the  working  parties, 
and  it  is  said  that  example  and  precept  seldom  fail  to  induce 
even  the  reluctant  to  work,  although,  nothing  in  the  charac- 
ter of  punishment  for  idleness  is  resorted  to.  The  farm 
stock  at  Woodilee  included  goodly  sized  herds  of  cattle  and 
flocks  of  sheep. 

The  sewage  is  utilized  on  the  land.  The  original  plan  was 
to  have  only  earth-closets ;  but  these  were  discarded,  owing 
to  difficulty  in  keeping  them  in  order.    The  closets  are  in  pro- 


148  SCOTLAND. 

jections  from  the  main  divisions.  No  sewers  enter  the  asy- 
lum buildings,  but  terminate  just  outside  the  walls,  where 
they  are  trapped  near  the  junction  of  a  ventilating  flue.  All 
interior  pipes  are  trapped  within  the  building,  and  are 
carried  through  the  wall  into  the  sewer.  The  sewer- 
pipes,  laid  below  frost  depth,  extend  to  a  large  covered  vat 
some  distance  from  the  asylum.  The  sewage  is  there  diluted 
and  forced  by  steam  pumps  through  iron  pipes  to  hydrants 
at  elevated  points  on  the  farm,  from  which  it  is  distributed 
over  the  land  by  means  of  movable  troughs.  The  fields 
thus  treated  were  much  improved.  The  main  iron  sewer- 
pipe  measures  five  inches,  and  the  others  three  inches  in 
diameter.  Intermediate  flues  act  as  a  protection  against 
sewer-gas.  The  system  is  highly  approved  by  the  Super- 
intendent, who  thinks  that  the  immediate  distribution  of 
the  sewage  obviates  any  danger  to  health. 

In  affording  employment,  the  laundry  is  to  the  women 
what  the  farm  is  to  the  men.  Machinery  has  been  discarded 
for  washing  by  hand.  The  clothes  are  dried  in  the  open 
air  when  the  weather  permits.  Out  of  a  total  of  one  hun- 
dred and  forty-five  Avomen  workers,  about  thirty  were  em- 
ployed at  laundry  work  ;  sixteen  were  assisting  in  wards  ; 
thirteen  in  the  kitchen  ;  two  w^ere  serving  as  housemaids ; 
fifty-nine  were  doing  needlework ;  and  twenty-six  were 
knitting. 

The  inmates  are  variously  and  comfortably  attired.  The 
night-dresses  in  use  in  the  several  divisions  are,  like  the  bed 
linen,  distinguished  by  different  colored  stripes.  The  male 
patients  generally  wear  stout  corduroy  or  moleskin  trousers. 
Male  attendants  wear  uniform  caps  displaying  the  asylum 
badge.  Female  attendants  are  dressed  in  black,  which  con- 
trasts well  with  their  clean  white  ruffed  caps,  white  linen 
cuffs,  and  white  aprons. 


WOODILEE. 


149 


Night  attendants  are  governed  by  rules  similar  to  those 
in  many  other  British  asylums.  It  is  the  first  duty  of  the 
night  attendant  to  ascertain  from  the  head  attendant  all 
names  of  patients  who  require  particular  attention  in  the 
administering  of  medicine  or  special  comforts,  and  of  those 
disposed  to  suicide.  Epileptic  and  suicidal  patients  must  be 
visited  every  hour  during  the  night,  and  every  patient  must  be 
looked  at  when  the  night  attendant  enters  upon  his  watch  at 
eight  o'clock  and  again  at  ten  o'clock.  Each  dormitory  must 
be  visited  at  regular  intervals  four  times  during  the  night.  All 
epileptic  and  paralytic  patients  must  be  examined  at  each 
of  these  visits,  and  if  the  linen  is  wet  or  soiled,  it  must  be 
changed  at  once.  The  night  attendants  are  further  required 
to  know  all  patients  of  irregular  habits.  These  must  be 
periodically  awakened  to  attend  to  the  calls  of  nature. 
Some  of  them  must  be  called  every  two  hours ;  others  only 
at  midnight  or  possibly  again  at  two  A.M.  It  is  explained  to 
the  attendants,  that,  with  the  exception  of  epileptic  patients 
in  a  fit,  these  precautions,  if  strictly  observed,  should  entirely 
obviate  all  wet  beds  in  ordinary  cases  of  chronic  mental  dis- 
ease, and  conduce  to  cleanly  habits  by  day.  Night  attend- 
ants are  required  to  make  a  particular  record  of  all  the  inci- 
dents that  occur,  including  the  manner  in  which  newly  ad- 
mitted patients  and  the  sick  have  passed  the  night.  To  rest- 
less patients,  the  night  attendants  are  urged  to  give  particular 
attention.  They  are  told  that  a  kind  word  will  often  bring 
the  patient  quiet  sleep,  while  its  omission  may  cause  him 
to  pass  a  noisy,  restless  night  with  consequent  excitement 
next  day.  The  attendant  is  also  told  that  the  timid  should 
have  their  fears  allayed  by  frequent  friendly  visits,  in  the  ex- 
pectation that  sound  sleep  may  be  secured  to  them  through 
the  consciousness  of  the  attendant's  presence.  Night  attend- 
ants   are    charged   with  the   duty   of  seeing  that   there    is 


150  SCOTLAND. 

nothing  done  after  the  inmates  have  retired  to  disturb  their 
rest.  At  5.30  A.M.  the  night  attendants  call  the  day  attend- 
ants. Until  breakfast-time  the  former  aid  in  dressing  and 
washing  the  patients. 

At  the  time  of  my  visit,  the  daily  routine  observed 
here  was  as  follows  :  The  morning  call  is  made  at  5.30. 
Day  attendants  superintend  the  washing  and  dressing  of 
patients,  and  see  that  their  beds  are  turned  down  and  ex- 
posed to  the  air.  At  6.30  artisans  and  selected  farm  and  gar- 
den patients  begin  work,  also  selected  kitchen  and  laundry 
patients.  At  7.30  the  attendants  take  breakfast.  At  8 
o'clock  the  patients  have  their  breakfast.  At  8.30  there  is 
morning  prayer  in  the  chapel.  At  9  o'clock  the  working 
male  patients  are  inspected  in  the  court,  and  they  after- 
wards go  out  to  labor.  At  the  same  hour  the  kitchen, 
laundry,  and  sewing  women  are  set  at  work.  At  10.30 
o'clock  a  medical  visitation  to  the  wards  is  made.  From 
10  to  II  extras  for  tJie  sick  are  issued  from  the  kitchen 
or  stores.  At  12  M.  medicines  are  dispensed  and  given 
to  the  head  attendant.  At  i  P.M.  working  patients  re- 
turn to  the  wards  and  make  themselves  tidy  for  dinner. 
At  1.20  o'clock  is  the  patients'  dinner,  and  the  attendants 
dine  twenty  minutes  later.  At  2  the  working  patients  re- 
turn to  work.  At  4  o'clock  extras  for  the  sick  are  issued 
and  tea  is  given  to  laundry  patients.  At  6  o'clock  in  sum- 
mer working  patients  return  to  their  wards.  At  6.20  pa- 
tients have  their  tea  or  supper ;  at  6.40  attendants  take 
their  supper.  From  7.30  to  8,  patients  go  to  bed  ;  all  shut- 
ters and  doors  are  locked,  clothing  removed  from  rooms, 
and  lights  extinguished.  A  second  medical  visit  is  made 
about  this  hour.  At  8,  night  attendants  enter  upon  their 
duties.  At  10  o'clock  all  attendants  except  those  on  duty 
go  to  bed  and  the  lights  are  extinguished.  The  rules  set  forth 


WOODILEE.  I  5  I 

that  the  hours  of  outdoor  exercise  shall  depend  upon  the 
weather  and  season  of  the  year,  and  that  two  hours  daily- 
should  be  spent  in  the  open  air  by  the  non-working  male 
and  all  the  female  patients. 

Two  corridors  inclosed  with  glazed  sash  extend  from  each 
wing  of  the  asylum  rearward  to  the  chapel  on  the  lawn. 
These  cheerful  promenades,  lined  with  fragrant  flowers, 
have  the  appearance  of  beautiful  conservatories,  and  afford 
pleasant  walks  in  the  most  disagreeable  weather.  In  the 
chapel — a  tastefully  built  stone  edifice  with  attractive 
stained-glass  windows — services  are  conducted  every  Sun- 
day by  a  local  pastor.  The  men  and  women  occupy  differ- 
ent sides  of  the  building.  There  are  religious  exercises 
here  every  morning,  consisting  of  singing,  reading,  and 
prayer. 

An  air  of  industry  pervaded  the  institution,  and  thorough 
administration  was  everywhere  apparent.  In  a  walk  about 
the  grounds  with  the  Superintendent,  a  considerable  force 
of  men  were  seen  grading,  planting,  and  making  other  im- 
provements. Others  were  engaged  on  the  lawns  and 
grounds,  working  with  little  or  no  manifestation  of  excite- 
ment. Successful  efforts  were  made  to  get  the  patients  in- 
terested in  their  work.  Both  patients  and  attendants  labored 
together,  the  latter  by  example  stimulating  and  encouraging 
the  former,  while  taking  care  to  prevent  undue  exertion  on 
the  part  of  the  patients. 

This  asylum  was  examined  with  peculiar  interest,  for  the 
reason  that  it  has  the  reputation,  beyond  any  other  of  its 
kind  in  Great  Britain,  of  making  practical  application  of  the 
most  advanced  theories  respecting  non-restraint  and  per- 
sonal freedom.  Of  this  feature  of  the  asylum  and  its 
results,  Dr.  Rutherford  says :  "  The  diminution  of  restraint 
is  beneficial,  inasmuch  as  it  renders  the  patients  more  con- 


152  SCOTLAND. 

tented,  and  makes  them  practise  self-restraint  more  than 
they  feel  disposed  to  do  when  others  seem  to  be  doing  it 
for  them.  Besides,  there  is  nothing  more  irritating  than 
forced  restraint.  Many,  inside  and  outside  the  asylum,  go 
about  and  work  unattended.  Freedom  does  not  increase 
the  number  of  suicides,  which  have  been  of  very  rare  occur- 
rence here.  Conflicts  with  attendants  are  also  rare  ;  and 
when  they  do  happen,  it  is  generally  indoors.  It  is  the  rule 
that  attendants,  under  no  pretext  whatever,  shall  leave  or 
lose  sight  of  a  patient  without  placing  him  under  the  care  of 
another  attendant,  and  the  rules  are  very  strict  respecting 
rude  treatment.  If  it  becomes  necessary  to  seclude  a  re- 
fractory patient,  the  fact  must  be  immediately  reported 
through  the  head  attendant  to  the  Medical  Superintendent. 
Under  this  system,  it  cannot  be  said  that  the  number  of  at- 
tendants is  actually  or  necessarily  increased.  The  excess,  if 
any,  is  of  that  class  of  attendants  who,  by  their  work,  earn 
their  wages,  and  are,  as  it  were,  extra  ;  such,  for  example,  as 
artisans  and  gardeners.  These  attendants  work  with  the 
patients,  and  are  generally  the  best  workers  in  the  party. 
The  patients  imitate  and  follow  the  attendant,  only  he  must 
be  able  to  handle  a  pick  and  shovel  better  than  they,  else  they 
will  work  very  little — they  will  simply  play  at  work.  Here, 
it  is  easy  to  get  such  attendants.  The  responsibility  of  the 
superintendent  is  not  increased.  Greater  vigilance  may  pos- 
sibly be  needed  on  the  part  of  attendants  to  prevent  escapes  ; 
though  under  the  system  of  enlarged  liberty  more  escapes 
do  not  occur  than  frequently  happened  in  the  old  lock-up 
institutions." 

In  respect  to  stimulating  beverages  and  medical  treat- 
ment. Dr.  Rutherford  says :  "  There  is  a  diminishing  use  of 
wine  and  spirits.  Beer  is  not  used  by  the  patients  as  an 
article  of  diet.     Forty  gallons  of   new  milk  are  consumed 


WOODILEE, 


153 


daily.  Sedatives  and  narcotics  are  not  used  except  where 
sleep  cannot  be  otherwise  obtained.  Only  twelve  out  of  the 
total  received  draughts  for  this  purpose  last  night.  Insanity 
is  essentially  a  disease  of  diminished  vitality,  and  when  pres- 
ent, the  system  demands  invigorating  treatment.  Experi- 
ence proves  that  there  is  nothing  so  invigorating  as  active 
outdoor  employment  and  abundance  of  fresh  air." 

Without  attempting  to  decide  to  what  extent  the  radical 
principles  put  in  practice  here  are  worthy  of  general  adop- 
tion, it  was  evident  that  there  was  a  remarkable  degree  of 
contentment  and  cheerful  activity.  The  visit,  on  the  whole, 
left  the  impression  that  the  Barony  Parochial  Asylum  was  con- 
ducted with  great  energy  and  ability,  and  that  it  is  entitled 
to  the  high  position  it  holds  among  British  institutions. 

The  number  of  patients  registered  on  the  books  of  the 
asylum  September  3,  1887,  was  531.  They  were  distributed 
as  follows  :  Within  the  main  building,  473  ;  residing  at  the 
Muckroft  farm,  12  men  and  2  women  ;  at  the  new  Farm 
Steading,  26  men  and  2  women  ;  at  Fauldhead,  8  women  ; 
and  at  the  Gate  Lodge,  6  men.  Two  women  were  absent 
on  pass.  The  net  per-capita  cost  of  maintenance,  as  offi- 
cially given,  was  8^.  <^d.  per  week,  for  the  financial  year 
ending  May  14,  1887.  The  force  of  attendants  has  been 
proportionately  enlarged  with  the  increase  of  numbers. 

Since  my  visit,  Dr.  Rutherford  has  been  called  to  assume 
charge  of  the  Crichton  Royal  Institution  at  Dumfries,  and 
has  been  succeeded  by  Dr.  Robert  Blair.  The  Lunacy 
Board  in  reporting  upon  the  institution  in  1887,  said: 
"  The  ample  means  of  industrial  occupation  afforded  by  the 
arrangements  of  this  asylum  continue  to  be  judiciously  taken 
advantage  of.  The  patients  were  free  from  complaint, 
noise,  or  excitement,  and  the  establishment  was  found  in 
excellent  order  throughout." 


154  SCOTLAND. 

MID-LOTHIAN   AND    PEEBLES   DISTRICT   ASYLUM. 

This  asylum  is  located  at  Rosewell,  a  few  miles  from 
Edinburgh,  and  is  easily  accessible  by  rail.  Its  site  is  seven 
hundred  feet  above  the  level  of  the  sea,  and  commands  ex- 
tensive and  pleasing  views  of  the  adjacent  country.  The 
asylum  was  opened  in  1874.  It  is  managed  by  an  unpaid 
district  board.  The  Medical  Superintendent  controls  the 
selection  of  the  subordinate  staff. 

In  the  original  estate  there  were  only  about  forty 
acres.  The  disadvantage  of  having  so  limited  an  area  led 
to  the  additional  purchase  of  a  small  farm  ;  but  even  with  this 
the  amount  of  land  is  found  to  be  insufficient.  The  plain 
and  new-looking  two-story  buildings  of  cut  stone,  having  ac- 
commodation for  about  two  hundred  patients,  were  erected 
at  a  cost  of  ^^50,000.  The  surrounding  grounds  are  well 
kept,  and  the  terraced  lawns  are  adorned  with  flowers  and 
shrubbery.  The  institution  has,  in  addition  to  the  main 
building,  two  convenient  and  comfortable  cottages  for 
attendants  and  patients. 

This  asylum  provides  for  the  requirements  of  the  landward 
district  of  Mid-Lothian  and  Peebles.  So  far,  it  has  had  ac- 
commodation to  spare  after  meeting  the  wants  of  the 
district  rated  for  its  support,  and  accordingly  a  number  of 
what  are  termed  "  out-county "  patients  are  received. 
About  one  fifth  of  the  inmates  are  private  patients,  who  are 
charged,  if  residing  within  the  district,  ii^.  6\d.  per  week, 
and  if  without,  14^'.  "  Out-county"  pauper  patients  are  re- 
ceived at  the  rate  of  \2s.  '^\d.  per  week.  The  rate  for  pau- 
per patients  within  the  district  is  officially  given  for  the  year 
ending  May  14,  1887,  ^s  10^.  A^^d.  This  includes  provisions, 
household  requisites,  medicines,  clothing,  salaries  and  wages, 
furniture  and  furnishings,  and  incidental  expenses. 

The   upper  floor  is  set  apart   chiefly  for  dormitory  pur- 


MID-LOTHIAN  AND  PEEBLES.  1 55 

poses.  On  the  lower  floor  are  the  sitting  or  day  rooms, 
dining-hall,  principal  lavatory,  a  few  single  rooms,  and  other 
apartments  for  day  use.  The  dormitories  vary  in  size,  con- 
taining from  fifteen  to  thirty  beds  each,  and  they,  as  well  as 
some  of  the  single  rooms,  appeared  to  have  insufificient  air 
space.  Flowering  plants  and  ferns  were  about  the  windows, 
which  have  plain  wooden  sashes  with  panes  8  x  10  inches. 
The  windows  are  ungrated,  and  are  generally  without 
either  shutters  or  blinds.  The  sash  can  be  lowered  at  the 
top  and  raised  at  the  bottom  about  six  inches.  Rugs  and 
breadths  of  Brussels  carpet  were  laid  on  the  waxed  floors. 
The  tinted  walls  had  bright  paper  borders.  The  bedsteads 
were  mostly  of  wood,  with  head  and  foot  boards.  The  mat- 
tresses were  in  three  sections.  The  bedding  was  abundant 
and  comfortable.  Some  woven-wire  mattresses  that  had 
been  received  on  trial  were  approved.  A  lavatory  examined 
on  the  upper  floor,  was  well  supplied  with  towels,  brushes, 
combs,  and  mirrors. 

In  the  dormitories,  even  in  the  single  rooms,  and  in  the 
apartments  generally,  are  fire-places.  These  are  supple- 
mented by  a  complete  system  of  steam-heating  with  direct 
radiation.  Ventilating  flues  are  in  the  walls.  The  lighting 
is  by  gas.  In  some  of  the  apartments  the  gas-jets  have 
frosted  globes.  Altogether,  there  are  from  thirty  to  forty 
single  rooms.  In  all  of  those  on  the  upper  floor  there  are 
concealed  adjustable  shutters,  by  means  of  which  the  win- 
dows may  be  effectually  protected.  It  was  said  that  these 
were  rarely  used. 

One  of  the  day  or  sitting  rooms  that  I  inspected  was  a 
pleasant  apartment  with  a  broad  and  deep  bay-window 
ornamented  with  lambrequins.  The  walls  were  tinted  and 
hung  with  pictures;  the  wood  casings  polished  and  var- 
nished, and  on  the  floor  were  cocoa-fibre  rugs  with  colored 


156  SCOTLAND. 

borders,  and  a  broad  piece  of  linoleum  extending  through 
the  centre  of  the  room.  The  chairs  and  lounges  were 
upholstered  with  enamelled  canvas.  A  billiard  table 
afforded  a  kind  of  recreation  that  was  much  appreciated 
by  the  patients.  Geraniums  and  other  flowering  plants  were 
here  displayed  to  advantage. 

Adjoining  this  was  a  goodly  sized  lavatory  with  floor  of 
colored  tile,  highly  polished  brass-work,  abundance  of  clean 
towels,  and  mirrors  on  the  walls  of  three  sides  of  the 
apartment.  The  infirmary  wards  were  very  comfortably  fur- 
nished. In  the  halls  and  corridors  the  walls  were  suitably 
colored,  the  ceilings  plainly  decorated,  the  windows  cur- 
tained, and  along  the  waxed  floor  was  a  breadth  of  bright 
linoleum  with  a  brass  protecting  border  screwed  firmly  to  the 
floor. 

The  men  and  women  have  their  meals  in  a  hall  which  had 
tinted  and  wainscotted  walls,  and  was  furnished  with  ordinary 
chairs,  tables  with  linen  covers,  crockery  plates,  knives, 
forks,  and  spoons.  One  end  of  the  room  was  apportioned  to 
male,  the  other  to  female  patients,  who  enter  by  different 
doors.  They  were  served  by  attendants,  one  of  whom  pre- 
sided at  the  head  of  each  table.  The  dinner  consisted  of 
broth,  beef,  potatoes,  and  bread. 

The  chapel,  which  is  also  used  for  entertainments,  has 
ornamental  interior  roof-work,  colored  glass  windows,  and, 
considering  its  purposes,  is  elegantly  fitted  up.  A  small  or- 
gan and  a  piano  were  on  the  platform.  This  was  covered 
with  Brussels  carpet,  and  a  breadth  of  the  same  was  laid 
along  the  passages,  the  clean  waxed  floor  showing  at  the 
sides.  The  seats  or  settees  were  comfortable  and  were 
conveniently  arranged. 

At  one  time  much  complaint  was  made  about  dampness, 
which  had  become  apparent  on  the  walls  of  the  day-rooms, 


MID-LOTHIAN  AND  PEEBLES.  1 57 

dormitories,  and  corridors  of  both  floors  of  the  asylum 
building.  To  obviate  this  serious  difficulty,  an  experienced 
builder  recommended,  among  other  things,  that  the  ex- 
posed portions  of  the  stone  walls  be  painted  with  sugar-of- 
lead  and  oil,  and  that  all  imperfect  stones  be  taken  out  and 
perfect  ones  substituted.  His  suggestions  were  acted  upon, 
and  the  result  was  satisfactory. 

There  were  neither  close  nor  padded  rooms,  and  it  was 
said  that  the  principle  of  non-restraint  was  observed  as  far 
as  possible.  In  certain  cases,  as,  for  example,  soothing  a 
patient  when  in  a  state  of  great  excitement,  some  such 
preparation  as  hyoscyamine,  or  perhaps  a  subcutaneous 
injection  of  some  kind,  was  resorted  to.  Muffs  were  hardly 
ever,  and  locked  dresses  never,  used.  The  attendants  at 
this  asylum  were  in  the  proportion  of  one  to  twelve  patients, 
and  their  pay  was  periodically  increased  according  to  merit 
and  length  of  service. 

Fifty  per  cent  of  the  men  in  suitable  weather  are  gen- 
erally occupied  on  the  farm  or  in  improving  the  grounds. 
These  appear  more  spacious  from  the  absence  of  walled 
airing-courts.  The  women  are  extensively  employed  at 
laundry  work,  sewing,  knitting,  and  house-cleaning.  The 
patients  were  not  uniformly  dressed.  Their  clothing  was 
substantial  and  comfortable.  In  winter,  the  men  who  go  out 
to  work  wear  heavy  plaids  and  thick  woollen  gloves.  Care  is 
taken  to  see  that  they  have  water-tight  shoes  in  good  order, 
and  also  that  their  strong  fustian  clothes  are  in  satisfactory 
repair.  In  stormy  weather,  labor  is  mainly  confined  to 
the  tailor's,  shoemaker's,  joiner's,  and  engineer's  workshops. 
Here,  in  the  country,  in  comparative  seclusion  and  under 
proper  supervision,  a  commendable  measure  of  freedom  is 
allowed. 


158  SCOTLAND. 

THE   ROYAL   EDINBURGH   ASYLUM — MORNINGSIDE. 

Two  miles  southwesterly  from  Edinburgh,  and  just  a  little 
removed  from  the  activities  of  the  picturesque  metropolis  of 
Scotland,  is  situated  the  Royal  Edinburgh  Asylum.  A  high 
place  is  deservedly  assigned  to  this  institution,  which,  like 
every  other  asylum  for  the  insane  in  Scotland,  is  managed 
by  an  unpaid  board.  It  was  organized  as  a  private  or  char- 
tered corporation,  but  it  has  come  to  serve  also  the  purpose 
of  a  district  asylum.  It  is  under  the  efficient  direction  of  Dr. 
T.  S.  Clouston,  one  of  the  foremost  of  British  alienists.  The 
asylum  comprises  three  separate  branches,  called  East 
House,  West  House,  and  Craig  House.  A  little  apart  from 
these,  and  separated  from  one  another,  are  several  small 
asylum  cottages  partly  hidden  by  foliage  and  surrounded 
by  green  lawns  and  blooming  parterres.  The  country 
prospect,  with  a  background  of  heath-clad  hills,  is  pleasing 
and  extensive. 

The  number  of  inmates  in  this,  the  largest  asylum  in 
Scotland,  averages  about  eight  hundred.  The  West  House 
is  occupied  by  about  five  hundred  pauper  patients,  and 
private  patients  who  pay  low  rates  for  board.  East  House, 
Craig  House,  and  Myreside  Cottage  are  occupied  by  patients 
paying  higher  rates.  In  addition  to  the  buildings  referred 
to,  the  directors  provide,  during  the  summer  months,  a  sea- 
side villa  at  Cockenzie,  a  fishing  village  ten  or  twelve  miles 
east  of  Morningside.  The  rate  charged  for  the  support  of 
pauper  patients  from  the  district  is  ;i^33  lOi".  per  annum. 
The  minimum  rate  for  private  indigent  patients  is  the  same. 
Other  private  patients  are  charged  ^84  and  upwards  per 
annum. 

This  asylum  has  a  charity  fund  of  about  ;^45,ooo,  created 
by  voluntary  contributions,  the  income  of  which  is  expended 
for  the  relief  of  deserving  patients  in  reduced  circumstances. 


MORNINGSIDE.  1 59 

About  ^14,000  have  recently  been  added  to  this  fund  by  the 
generous  bequest  of  Mrs.  EHzabeth  Bevan,  daughter  of  Dr. 
Andrew  Duncan,  who  was  one  of  the  first  Physicians  in 
Ordinary  to  the  asylum. 

The  West  House  is  a  plain-looking  but  substantially  built 
brick  structure  standing  a  little  apart  from  East  House.  At 
the  entrance  gate  we  met,  in  charge  of  attendants,  about  a 
score  of  women  comfortably  and  variously  attired,  who  were 
quietly  taking  their  daily  walk.  Near  the  shaded  avenue, 
a  considerable  number  of  patients  were  seen  at  work  with 
attendants.  The  well-kept  garden,  neatly  trimmed  lawn, 
carefully  raked  gravelled  walks,  and  a  profusion  of  flowers 
and  shrubbery  in  their  summer  splendor,  denoted  well- 
directed  labor.  Looking  over  the  spacious  and  highly  im- 
proved grounds,  the  eye  failed  to  detect  any  sign  of  irksome 
restriction  in  the  form  of  interior  walls  or  other  barriers. 
Connected  with  the  asylum  proper  were  about  one  hundred 
and  forty  acres  of  land,  portions  of  which  were  set  apart  for 
bowling,  lawn  tennis,  cricket,  and  other  outdoor  games.  The 
cricketers,  organized  as  a  club,  were  playing  a  friendly  match 
with  a  team  from  the  city. 

On  the  day  of  my  visit,  the  dinner  for  the  pauper  class  con- 
sisted of  hotch-potch  (a  wholesome  vegetable  soup),  a  liberal 
allowance  of  corned  beef,  with  abundance  of  potatoes  and 
bread.  The  poorer  class  of  paying  patients  received,  instead 
of  corned  meat,  roast  beef  with  cabbage  and  other  vegeta- 
bles. All  were  allowed  ale,  but  some,  by  special  order,  re- 
ceived milk.  Separate  dining-halls  are  provided  for  the  pau- 
per and  paying  patients.  At  meal  time  an  attendant  is  sta- 
tioned at  either  end  of  each  table  to  apportion  and  serve  the 
food.  The  hours  for  regular  meals,  are — breakfast  at  eight 
A.M.,  dinner  at  two  P.M.,  and  tea  at  six  P.M. 

Pauper   inmates  have   three   meals  ;    non-pauper  inmates 


l6o  SCOTLAND. 

are  allowed  a  supper  in  addition.  Attendants  take  their 
meals  in  their  own  rooms  half  an  hour  before  the  patients 
have  theirs.  Most  of  the  food  is  prepared  in  a  general  kitchen. 
Small  diet  kitchens  adjoin  the  apartments  for  the  sick.  In 
cold  weather  the  plates  are  warmed  before  serving  the  meals. 
In  the  culinary  department  the  head  female  cook  is  assisted 
by  three  attendants  and  about  eighteen  patients.  The  large 
dining-hall  has  frescoed  ceiling  and  varnished  wooden  rafters, 
and  is  lighted  from  the  roof.  Here  are  several  rows  of  ta- 
bles with  white  linen  covers.  The  men  and  women  occupy 
opposite  sides  of  the  hall.  Plates  of  earthen-ware,  horn 
spoons,  knives  and  forks,  pepper-boxes,  salt-cellars,  mustard 
pots,  and  water-bottles  were  on  each  table.  The  knives 
have  only  about  one  and  a  half  inch  of  cutting  edge.  The 
floor  is  of  plain  wood,  and  it  was  cleanly  scrubbed.  At  one 
end  of  this  dining-hall  is  a  raised  platform,  the  apartment 
being  occasionally  used  for  concerts  and  other  entertain- 
ments. There  is,  in  addition,  a  large  recreation  hall  set 
apart  solely  for  entertainments.  This  hall  is  handsomely 
decorated,  and  the  side  lights  have  bright-colored  shades. 
The  system  of  heating  is  by  hot  water. 

The  dining-hall  for  poorer  paying  patients  accommodates 
about  one  hundred  at  five  tables,  each  of  which,  with  its 
white  linen  cloth,  was  arranged  to  seat  twenty  persons.  The 
chairs  were  of  cherry  wood,  which  was  highly  polished. 
Knives  and  forks  were  used.  Earthen  plates,  casters,  and 
water-bottles  were  on  the  different  tables.  A  mahogany 
sideboard  and  other  homelike  articles  improved  the  appear- 
ance of  the  hall,  which  was  lighted  by  gaseliers  and  side  lights. 
Throughout  the  house  one  is  pleased  with  the  general  dis- 
tribution of  comfortable  furniture,  the  arrangements  for  dif- 
fusing cheerful  light,  and  the  effect  of  brilliant  coloring. 

Patients,  on  leaving  for  work,  pass  through  what  is  called 


MORNINGSIDE.  l6l 

the  "  shoe-house,"  against  the  walls  of  which  are  ribbt;d  shoe- 
presses  with  separate  divisions  for  keeping  boots  and  shoes, 
one  division  being  assigned  to  each  person.  The  workers 
are  divided  into  parties  of  ten  or  twelve,  each  group  being 
in  charge  of  a  working  attendant.  On  their  return  from 
labor,  the  patients  assemble  in  a  court  with  side  shelters. 
The  tools  are  restored  to  their  places,  and  something  like 
military  order  is  observed.  Labor  is  found  to  be  an  effective 
aid  in  treatment,  and  the  weather  and  circumstances  permit- 
ting, every  male  patient  is,  shortly  after  his  reception,  set 
at  work  in  the  garden.  During  the  first  three  days  he  is  un- 
der close  observation.  If  a  patient  proves  troublesome  and  is 
disinclined  to  work,  or  disposed  to  hinder  others,  he  is  placed 
under  the  special  charge  of  an  attendant.  The  whole  indus- 
trial department  is  intelligently  supervised.  The  carpenter's 
shop  is  a  well-lighted  room,  in  which  were  employed  two 
paid  joiners  and  four  working  patients  in  making  and  repair- 
ing tables,  chairs,  wardrobes,  wash-stands,  mantel-pieces, 
boxes,  etc.  Paid  workers  were  also  observed  in  other  places 
as  follows  :  In  the  tailor's  shop,  employed  in  making  clothing 
and  bedding,  and  in  the  shoemaker's  shop,  one  attendant  to 
every  four  patients ;  in  the  upholsterer's  shop,  engaged  in  mak- 
ing straw  and  hair  mattresses,  feather  pillows,  covering  chairs, 
and  upholstering  old  furniture,  one  attendant  to  three 
patients  ;  in  the  tin-smith  and  plumber's  shop,  two  to  the 
same  number  of  patients;  and  in  the  bakehouse,  two  to  one 
patient.  In  the  smithy,  three  patients  worked  as  blacksmiths. 
In  another  division  about  twenty  patients  in  charge  of  two 
working  attendants  were  picking  hair  for  mattresses  and 
pillows. 

In  all  of  the  mechanical  departments  ordinary  tools  are 
used.  Implements  are  carefully  kept  and  must  be  accounted 
for  by  those  using  them.     In  the  printing-office  were  three 


1 62  SCOTLAND. 

working  patients  who  not  only  print  the  reports  and  blank 
forms  used  in  the  institution,  but  also  a  monthly  periodical 
called  the  "  Morningside  Mirror,"  to  which  the  inmates  con- 
tribute. The  windows  of  the  workshops  have  ordinary 
wooden  sash,  the  panes  measuring  6x8  inches.  Not- 
withstanding the  freedom  here  permitted  and  the  use  of 
numerous  tools,  it  was  asserted  that  personal  injuries  are  of 
rare  occurrence.  The  laundry  gives  employment  to  a  con- 
siderable number  of  women,  and  is  a  well-organized  depart- 
ment. For  sanitary  reasons,  the  clothes  are  dried  in  the 
open  air  when  the  weather  permits. 

Stores  are  orderly  arranged,  and  are  given  out  only  on  ap- 
proved requisitions  from  the  several  departments. 

In  the  older  portions  of  the  asylum,  there  are,  in  some 
cases,  from  forty  to  fifty  patients  in  an  associated  dormi- 
tory ;  in  the  newer  parts,  but  from  six  to  twenty.  There  is 
a  considerable  number  of  single  rooms.  In  some  of  those 
occupied  by  violent  patients,  inside  sliding  shutters  are 
provided  for  use  at  night.  Some  of  the  bed-frames  have  ad- 
justable bottoms  of  strong  canvas,  and  each  is  furnished 
with  a  hair  mattress.  In  addition  to  other  means  of  heating, 
open  fires  are  general.  Dr.  Clouston  prefers  pitch  pine  for 
flooring,  and  many  of  the  floors  are  of  this  material.  They 
are  carefully  waxed,  and  present  a  glossy  and  even  elegant 
appearance.  In  the  lavatories  there  are  highly  polished  heavy 
copper  basins.  The  baths  are  furnished  with  every  con- 
venience. The  closets  are  in  structures  separate  from  the 
wards,  but  connected  by  passage-ways.  Except  at  a  por- 
tion of  West  House,  the  open-door  system  generally  prevails, 
the  doors  remaining  unfastened  in  summer  until  ten  P.M. 

Walled  enclosures  or  airing-courts  have  been  abolished  at 
this  institution.  One  of  the  first  things  Dr.  Clouston  did 
after  his  appointment  in  1873  '^^^s  to  remove  the  iron  gratings 


MORNINGSIDE.  163 

from  the  windows  of  the  asylum  and  take  down  from 
about  the  airing-courts  the  then  existing  high  walls.  The 
marks  where  these  unsightly  barriers  terminated  against  the 
East  House  may  still  be  seen.  In  their  place  has  been  substi- 
tuted, in  some  instances,  a  low  stone  wall  surmounted  by  an 
ornamental  balustrade,  which  does  not  obstruct  the  range  of 
vision.  One  such  limits  the  recreation  grounds  for  women 
at  the  East   House. 

In  the  pauper  department  the  means  of  restraint  consists 
of  gloves  and  the  old  strait-jacket  or  "  polka  "  ;  but  these 
are  so  rarely  used,  it  was  asserted,  that,  practically  speaking, 
there  was  no  mechanical  restraint.  Sometimes  seclusion  is 
resorted  to  in  a  light  room  ;  at  other  times  in  a  dark  apart- 
ment. In  each  division  of  the  West  House  there  is  a 
canvas-padded  room, — one  for  men  and  the  other  for 
women.  These  are  warmed  as  occasion  requires,  and  may 
be  lighted  from  the  ceiling.  At  the  East  House  were  seen 
two  male  patients  who  had  been  in  close  charge  of  attend- 
ants for  the  previous  four  days.  One  was  comparatively 
quiet  ;  the  other  exceedingly  boisterous  and  wild,  running 
and  shouting  around  the  green,  the  watchful  guardian  all 
the  while  keeping  close  by  and  permitting  him  to  spend  his 
superfluous  energy  without  injuring  himself  or  others. 

The  training  of  the  attendants  is  manifestly  of  a  high 
order,  developing  patience  and  even  tenderness.  Before 
entering  active  service,  they  are  instructed  in  the  duties  of 
the  various  departments.  For  cases  requiring  temporary 
attention  at  their  own  homes,  a  trained  attendant  is  some- 
times sent  outside  the  institution,  but  only  for  short  periods, 
and  at  fixed  rates.  Patients  are  brought  to  the  asylum  from 
the  Edinburgh  district  free  of  charge;  from  a  greater  dis- 
tance the  rate  is  ten  shillings  per  day  for  an  attendant,  with 
travelling  expenses.      At  the  time  of  my  visit,  a  party  was 


164  SCOTLAND. 

seen  starting  from  the  door  of  the  East  House  for  the  sea- 
side resort  at  Cockenzie.  It  consisted  of  two  male  and  ten 
female  patients,  who  were  comfortably  seated  in  a  large  open 
carriage,  and  accompanied  by  one  male  and  one  female  at- 
tendant, besides  the  driver.  From  their  dress  and  general 
appearance,  they  might  have  been  taken  for  a  party  of  ordin- 
ary pleasure-seekers. 

The  East  House,  as  already  stated,  is  occupied  entirely 
by  paying  patients.  In  passing  through  its  various  apart- 
ments, one  is  pleased  to  note  the  comfortable  and  homelike 
furnishings,  of  which  there  is  a  great  variety.  There  are 
sofas,  lounges,  rocking  and  easy  chairs,  mirrors,  draped  cur- 
tains, chair-beds  for  attendants,  Brussels  carpets,  carpet  rugs, 
solid  mahogany  dressing-cases  and  chests  of  drawers,  towel 
rails,  basins,  stands,  and  cabinets.  There  are  also  open  fire- 
places. On  the  men's  side,  are  rooms  for  billiards  and 
other  games,  and  pleasant  reading-rooms  with  well-stocked 
book-cases.  The  dining-rooms  at  East  House  are  small. 
In  one  fitted  up  in  oak  and  appropriately  decorated,  six- 
teen patients  were  assigned  to  a  table. 

In  the  women's  department,  the  furnishings  and  fittings 
are  also  tasteful  and  comfortable,  with  possibly  a  greater 
■profusion  of  homelike  articles.  Green  Venetian  blinds,  white 
lace  curtains,  mantel-pieces,  mirrors  in  gilded  frames,  gilt 
time-pieces  under  glass  shades,  carved  chimney  pieces,  paint- 
ings, flowers,  birds,  and  many  ornamental  articles  were  here 
seen.  The  windows  have  pleasant  outlooks.  In  chilly 
weather  bright,  copper  gas-stoves  are  used  to  temper  the 
atmosphere.  The  whole  department  was  in  charge  of  a 
matron,  and  bespoke  careful  management  as  well  as  good 
taste.  In  few  other  asylums  visited  did  the  inmates  ap- 
proach so  near  the  appearance  of  sane  people  in  home-life. 

In  regard  to  permitting  the  insane  to  act  out  their  pe- 


MORNINGSIDE.  1 65 

culiar  fancies,  Dr.  Clouston  says :  "  We  now  discourage  and 
keep  down  those  outward  expressions  of  insane  delusions 
that  used  to  give  a  lunatic  asylum  its  most  striking  character. 
The  monarchs  crowned  with  straw,  the  duchesses  in  gaudy 
spangles,  the  field-marshals  with  grotesque  imitations  of 
military  uniform,  that  could  be  seen  in  any  asylum  of  old, 
have  disappeared  in  outward  semblance,  just  as  in  the  world 
at  large  you  may  meet  an  empress  and  not  know  her.  The 
public  opinion  against  individuality  is  as  strong  now  in 
asylums  as  in  society.  If  the  man  with  ten  millions  of 
money,  who  is  the  rightful  heir  to  the  throne,  affixes  the 
top  of  a  soda-water  bottle  to  the  front  of  his  cap,  as  a  faint 
symbol  of  his  position,  it  is  at  once  unfastened.  If  the 
princess,  who  is  the  greatest  beauty  in  Europe,  bedecks  her- 
self with  brilliant  bits  of  incongruous  ribbon,  it  is  quietly 
removed  at  night.  The  insane  man,  like  his  sane  brother, 
soon  adapts  himself  to  his  circumstances,  and  submits  to 
rule  and  public  opinion." 

Since  my  visit,  some  very  desirable  changes  have  been 
wrought  in  Morningside,  enabling  the  Superintendent  to 
put  in  practice  some  of  his  excellent  theories  respecting 
asylum  management.  A  description  of  the  important 
improvements  effected  in  the  West  House,  may  be  best 
set   forth   in  his  own  words. 

"After  the  female  wards  Nos.  i,  2,  and  3  in  the  West 
House  were  finished  and  painted  and  refurnished  to  some 
extent,  the  two  West  House  dining-halls  were  repainted  and 
decorated  in  an  extremely  tasteful  and  cheerful  style.  The 
comfort  of  management,  and  the  advantage  to  the  patients, 
of  all  that  has  been  done  to  improve  the  house,  is  incalcula- 
ble. We  are  trying  to  individualize  and  classify  the  patients 
in  the  ward  for  the  admission  of  the  rate-paid  women,  who 
are  not  sick  or  very  weak  in  body,  on  the  principles  adopted 


1 66  SCOTLAND. 

for  the  care  and  cure  of  the  sick  and  weak  in  the  hospital 
wards.  That  impHes,  first  of  all,  a  large  staff  of  attendants 
there,  and  good  attendants.  This  ward  consists  of  three 
sections,  with  two  large  corridors.  There  is  much  elbow- 
room  everywhere,  the  average  floor-space  to  each  patient 
being  sixty  superficial  feet,  so  that  there  is  no  huddling  to- 
gether of  patients.  The  first  section  is  a  workroom  under 
the  charge  of  a  special  attendant,  where  every  suitable  pa- 
tient is  at  once  tried,  and,  if  possible,  got  to  do  something, 
thereby  the  mind  being  diverted  from  morbid  thoughts, 
while  self-control  is  practised  and  tidiness  of  dress  cultivated. 
The  work-hours  are  short,  with  walking  in  the  grounds  be- 
tween. The  next  division  of  the  ward  is  a  large  cheerful 
saloon  with  a  corridor  ten  feet  wide,  where  the  patients  who 
are  admitted  in  a  more  excited  state,  or  the  very  suicidal, 
are  placed.  Such  patients  arc  put  under  the  individual 
charge  of  one  or  two  attendants,  whose  duties  are  confined 
to  them  alone.  Individualization  is  the  key-note  in  this  sec- 
tion. Lastly,  there  is  a  smaller  sitting-room,  with  a  corridor 
attached,  for  a  few  who  are  safe  to  themselves  and  others, 
and  do  not  need  so  much  supervision,  and  where,  in  fact,  the 
sort  of  patients  are  apt  to  be  allowed  to  sit  who  from  delu- 
sions are  specially  intolerant  of  too  minute  supervision  (for 
there  is  an  immense  variety  in  the  symptoms  of  mental  dis- 
ease that  has  to  be  provided  for),  and  are  best  left  alone,  for 
a  time  at  least.  The  sleeping  accommodation  is  also  varied, 
consisting  of  two  large  dormitories,  in  one  of  Avhich  every 
new  patient  sleeps  for  the  first  few  nights  at  least,  and  where 
a  night-nurse  sits  up  and  makes  a  written  report  to  me  every 
morning  for  the  first  fortnight,  as  to  how  every  new  patient 
has  slept.  In  the  next  dormitory  four  attendants  sleep  near 
the  new  patients.  Then  there  are  two  dormitories  for  four 
patients  each,  and   two  with   three   beds,  and   twelve  single 


MORNINGSIDE.  1 67 

bedrooms.  The  whole  ward  accommodates  forty-three  pa- 
tients and  their  seven  attendants.  I  look  on  it  as  being  of 
the  utmost  importance  how  the  new  patients  are  treated 
and  cared  for,  what  first  impressions  are  made  on  their 
minds,  and  how  their  cases  are  gone  into." 

In  a  detached  two-story  cottage,  formerly  the  residence 
of  the  superintendent,  are  accommodated  four  ladies  who 
provide  their  own  attendants.  The  immediate  surroundings 
of  the  cottage  are  beautified  by  rockeries,  flowers,  shrub- 
bery, and  well-kept  walks.  The  windows  have  each  two 
large  panes  of  plate  glass,  and  they  are  provided  with  inside 
shutters,  green  Venetian  blinds,  and  white  lace  curtains. 
The  sashes  may  be  raised  or  lowered  a  few  inches  for  venti- 
lation. 

Myreside  Cottage,  a  cozy-looking,  old-fashioned  farm- 
house, with  vine-covered  porch  and  thatched  roof,  is  reached 
after  a  short  walk  from  the  East  and  West  houses.  It 
was  successfully  converted  from  a  private  dwelling  into  a 
home  for  male  patients.  At  the  time  of  my  visit  there 
resided  here  nine  persons  in  charge  of  two  male  attendants, 
who  said  their  duties  were  not  difficult.  The  doors  were 
unlocked.  A  woman  cook  and  a  sculler}-  maid  are  here 
constantly  employed.  A  room  up-stairs  is  used  as  a  dining 
and  sitting  room.  Open  fire-places  assist  ventilation.  No 
gratings  appeared  on  the  windows,  nor  were  there  any 
visible  barriers  ;  indeed,  the  house  did  not  differ  from  an  ordi- 
nary rustic  dwelling.  At  one  end  of  the  cottage,  in  a  small 
green-house,  were  pots  of  bright  geraniums,  carnations,  cal- 
ceolaria, ferns,  etc.  Fruit-trees  were  trained  closely  to  the 
garden  walls.  In  front  there  is  a  small  lawn  planted  with 
flowers  and  ornamental  shrubbery. 

As  one  proceeds  along  a  wooded  slope,  about  a  mile  from 
the  main  buildings  an  ancient   and  secluded  mansion,  sur- 


1 68  SCOTLAND. 

rounded  by  tall  ancestral  trees,  arrests  his  attention.  The 
approach  to  this  retreat,  known  as  Craig  House,  and  now 
used  as  a  receptacle  for  the  highest  class  of  paying  patients, 
is  through  a  gradually  ascending  avenue  bordered  with 
sycamores,  the  rugged  arms  of  which  form  a  lofty,  inter- 
lacing arch.  The  picturesque  appearance  of  the  building  is 
heightened  by  its  ancient  crow-stepped  gables  and  lofty 
chimney  stacks,  its  recessed  portal,  and  the  green  ivy  which 
is  seen  climbing  to  the  topmost  peak  of  the  left  wing.  From 
the  lawn  the  prospect  is  delightful,  embracing  Edinburgh, 
the  Firth  of  Forth,  and  surrounding  country,  while  Arthur's 
Seat  looms  up  grandly  in  the  distance.  The  place  is  historic. 
On  the  Borough  Muir  below,  a  memorial  stone  marks  the 
spot  where  the  Scottish  standard  was  unfurled  under  James 
IV.  prior  to  the  disastrous  battle  of  Flodden  Field.  It  is 
asserted  that  Scott  took  the  hill  on  which  Craig  House 
stands  as  the  point  of  observation  for  the  following  de- 
scription  in   Marmion  : 

"  Still  on  the  spot  Lord  Marmion  stayed, 
For  fairer  scene  he  ne'er  surveyed. 
When  sated  with  the  martial  show 
That  peopled  all  the  plain  below, 
The  wandering  eye  could  o'er  it  go, 
And  mark  the  distant  city  glow 
With  gloomy  splendor  red  ; 
For  on  the  smoke-wreaths,  huge  and  slow. 
That  round  her  sable  turrets  flow. 
The  morning  beams  were  shed, 
And  tinged  them  with  a  lustre  proud, 
Like  that  which  streaks  a  thunder  cloud." 

This  mansion,  some  three  hundred  years  ago,  was  the  seat 
of  the  Carmichaels,  a  family  of  distinction  in  early  Scottish 
annals.  Here  was  the  home  of  Lady  Carmichael,  one  of  the 
four  Maries  of  the  ill-fated  Mary  Queen  of  Scots,  and  it  is 
asserted  that  the  unfortunate  queen  herself  frequently  graced 


MORNINGSIDE.  1 69 

by  her  presence  the  halls  of  this  venerable  edifice.  It  was 
a  favorite  hunting-seat  of  James  V.,  and  Cromwell,  when  in 
Scotland  with  his  Ironsides,  made  the  place  his  headquar- 
ters, Craig  House  is  in  keeping  with  the  troublous  times  in 
which  it  originated,  having  been  designed  for  shelter  and 
defence.  It  is  strongly  built,  with  deep  foundations,  and 
some  of  the  walls,  as  seen  in  the  vaulted  kitchen,  are 
of  great  thickness.  Interest  in  the  place  is  enhanced  by  the 
discovery,  in  later  days,  of  a  secret  corridor  or  passage-way 
connecting  its  subterranean  vaults  with  the  fields  below. 

It  were  difificult  to  describe  the  interior  of  this  old-time 
mansion  with  its  rambling  halls,  hidden  nooks,  unexpected 
stairways,  and  numerous  rooms,  including  spacious  saloons 
that  still  retain  evidences  of  their  former  grandeur.  It  is 
much  to  the  credit  of  the  management  that  the  restorations 
necessary  to  its  present  use  are  in  conformity  with  the 
period  in  which  it  was  built.  The  furnishing  and  accommo- 
dations are  on  a  scale  of  the  highest  comfort,  if  not  luxury, 
and  quite  in  harmony  with  the  external  surroundings.  As- 
cending a  flight  of  richly  carpeted  stone  stairs,  one  notices 
that  the  carved  oak  doors  are  strengthened  by  iron  studs, 
and  that  they  have  old-style  wrought  iron  hinges  and  hang- 
ing iron  handles.  The  apartment  now  used  as  a  dining- 
room  is  an  interesting  part  of  the  mansion.  The  great 
arched  fire-place,  nine  feet  wide,  with  its  ancient  fire-dogs 
and  bright  tile,  suggests  the  generous  hospitality  of  by-gone 
days.  The  dark  oak-panelled  walls,  carved  oak  mantels  and 
furniture,  and  other  appointments  are  in  the  style  of  Holy- 
rood  Palace,  Among  other  decorations,  there  is  painted  on 
a  stone  set  in  the  wall  a  landscape,  in  which  appears  a 
castle  of  mediaeval  time,  with  its  moat  and  bridge.  In  the 
lobby  adjoining  are  quaint  old  paintings,  set  in  the  skilfully 
carved  oak  panels  of  the  walls. 


170  SCOTLAND. 

The  drawing-rooms  are  on  a  corresponding  scale  of 
elaborate  furnishing  and  decoration.  These  apartments 
command  a  fine  view  of  the  northeast,  and  communicate 
with  a  beautiful  garden,  which  is  kept  in  high  condition  by 
the  aid  of  patients  drafted  from  the  West  House.  This  is  a 
most  delightful  spot.  The  grounds  are  terraced  and  double 
banked,  and  laid  out  in  the  fashion  of  a  past  period.  They 
were  exquisitely  kept,  and  planted  with  shrubs,  creepers, 
and  rare  flowers,  whose  delicate  fragrance  filled  the  atmos- 
phere with  sweetness. 

Violent  patients  are  not  received  here,  and  there  are  no 
locks  and  keys,  nor  bars  and  bolts,  nor  other  restrictions  on 
personal  freedom,  except  the  watchfulness  of  numerous 
attendants.  It  should  be  stated  that  the  sashes  of  the  upper 
windows  are  so  adjusted  as  to  permit  of  being  moved  only 
a  few  inches  at  the  top  and  bottom.  There  is  an  entire 
absence  of  gratings  or  inside  shutters.  It  has  been  found 
that  patients  are  greatly  benefited,  when  recovering,  by 
removing  them  from  the  surroundings  unpleasantly  associ- 
ated with  the  acute  stage  of  their  disease  to  this  retired  and 
quiet  place.  Besides,  the  lawn  and  woods  of  Craig  House 
afford  opportunity  for  patients  from  other  portions  of  the 
asylum  to  take  air  and  exercise,  numbers  of  whom  enjoy  the 
shade  and  soothing  repose  of  this  elevated  sylvan  retreat. 
Respecting  the  desirability  of  change  in  surroundings,  Dr. 
Clouston  says  :  "  Patients  laboring  under  different  kinds  of 
mental  disorder,  even  in  different  phases  of  the  same  attack, 
are  better  treated,  and  have  a  greater  chance  of  recovery, 
through  having  this  variety  of  accommodation.  In  the  acute 
stage,  a  case  needs  more  of  a  hospital;  in  the  convalescent 
stage,  more  of  an  ordinary,  cheerful  house." 

As  I  left  Craig  House  in  the  soft  repose  of  a  dreamy  sum- 
mer afternoon,  the  sunlight  breaking  through  the  surround- 


M  ORNINGSIDE.  1 7 1 

ing  foliage,  as  the  spirit  of  benevolence  in  this  institution 
breaks  through  the  shadows  of  the  unfortunate  Hves  that 
find  a  home  and  refuge  here,  the  fitness  of  the  place  for 
the  special  purpose  to  which  it  is  devoted  was  impressed 
upon  my  mind  ;  and  with  a  parting  look  at  "  the  mansion 
with  a  strange  history,"  and  the  grand  old  trees  about  it, 
I  bespoke  a  blessing  on  those  whose  wise  forethought  had 
turned  this  interesting  relic  of  the  past  to  its  present 
beneficent  use. 


CHAPTER  IV. 
IRELAND. 

THE  first  asylum  for  the  insane  in  Ireland  was  founded 
by  Dean  Swift,  and  was  opened  in  1745.  Although 
nearly  a  century  and  a  half  has  elapsed  since  its  establish- 
ment, St.  Patrick's  Hospital,  of  Dublin,  still  continues  its 
work  of  mercy,  the  expense  of  maintaining  it  being  princi- 
pally met  by  the  revenue  derived  from  its  original  endow- 
ment. The  good  example  set  by  the  Reverend  Dean  did 
not,  however,  stimulate  others  to  the  performance  of  similar 
acts  of  generosity,  nor  did  it  arouse  the  Government  from 
its  indifference  to  the  needs  of  the  insane.  As  might  be 
expected  in  a  country  for  a  long  time  in  an  unsettled  condi- 
tion and  suffering  under  financial  depression,  the  mentally 
afflicted  were  sadly  neglected.  Illustrative  of  the  misery 
of  those  who  were  restrained  in  their  own  homes,  a  member 
of  the  House  of  Commons,  in  testifying  before  a  committee 
in  1 817,  said  : 

"  There  is  nothing  so  shocking  as  madness  in  the  cabin  of  the 
Irish  peasant,  where  the  man  is  out  laboring  in  the  fields  for  his 
bread,  and  the  care  of  the  woman  of  the  house  is  scarcely  suffi- 
cient for  attendance  on  the  children.  When  a  strong  man  or 
woman  gets  the  complaint,  the  only  way  they  have  to  manage  is 
by  making  a  hole  in  the  floor  of  the  cabin,  not  high  enough  for 
the  person  to  stand  up  in,  with  a  crib  over  it  to  prevent  his  get- 
ting up.  The  hole  is  about  five  feet  deep,  and  they  give  this 
wretched  being  his  food  there,  and  there  he  generally  dies." 

172 


CRUELTY  OF  OFFICIALS.  1 73 

Subsequently  another  witness  before  a  later  parliamentary 
committee  affirmed  that  he,  too,  had  'seen  cases  analogous 
to  the  above. 

It  is  not  to  be  assumed,  however,  that  such  practice  pre- 
vailed generally  throughout  Ireland  ;  and  where  it  did  exist, 
it  should  not  be  regarded  as  evidence  of  intentional  cruelty. 
It  must  be  borne  in  mind  that  there  was  almost  an  entire 
lack  of  asylum  accommodation  ;  that  a  popular  prejudice 
existed  against  what  were  called  "mad-houses";  and  that 
the  strong  love  of  home  and  kindred  among  the  Irish 
people  resists  the  separation  of  families. 

But  no  excuse  can  be  found  for  the  manner  in  which  the 
insane  poor  under  public  care  were  treated  in  Ireland  in  the 
early  part  of  the  present  century.  This  is  as  justly  subject 
to  censure  as  was  the  treatment  of  the  same  class  in  England 
or  Scotland.  It  appears  that  it  was  once  the  mode  in  con- 
veying lunatics  to  Dublin  to  tie  them  to  the  back  of  a  car 
and  compel  them  to  go  the  entire  distance  on  foot,  however 
long  or  short  it  might  be.  This  practice  is  referred  to  in  the 
report  of  a  parliamentary  commission  wherein  it  is  recorded 
that  a  physician  of  note  said  in  the  year  1808  :  "  I  give  you 
my  honor  that  of  the  insane  persons  sent  up  to  Dublin, 
almost  one  in  five  loses  an  arm  from  the  tightness  of  the 
ligature  producing  mortification,  which  renders  amputation 
necessary."  Sane  and  insane  were  crowded  together  in  the 
houses  of  industry  or  correction.  Sometimes  as  many  as 
three  were  chained  in  one  bed,  and  in  some  instances  a 
chained  lunatic  and  a  sane  pauper  shared  a  single  bed  be- 
tween them.  With  few  exceptions,  wherever  they  were  con- 
fined there  was  a  lamentable  absence  of  almost  every  requi- 
site for  the  peculiar  wants  of  the  insane. 

In  1804,  the  attention  of  the  Government  was  directed  to 
the  urgent  need  of  asylum   accommodation  for  the  insane 


174  IRELAND. 

poor  in  Ireland,  but  nothing  was  done  in  the  way  of  extend- 
ing public  relief. 

Again,  in  1810  the  Government  made  an  inquiry  into  the 
wants  of  the  insane  in  that  country,  the  result  of  which  was 
an  appropriation  by  Parliament  for  the  building  of  an 
asylum  at  Dublin  for  the  reception  of  insane  persons  from 
the  whole  of  Ireland.  This  institution,  opened  in  181 5,  was 
subsequently  enlarged,  and  is  now  known  as  the  Richmond 
District  Lunatic  Asylum. 

Before  18 10  there  was  no  regularly  organized  asylum  in 
Ireland,  except  that  founded  by  Dean  Swift.  There  were 
four  houses  of  industry  or  correction  into  which  the  insane 
were  received.  These  were  located  at  Dublin,  Cork,  Lim- 
erick, and  Waterford,  but  they  could  not  properly  be 
regarded  as  asylums. 

The  reports  following  successive  parliamentary  inquiries  at 
length  led  the  Government  to  take  energetic  steps  towards 
ameliorating  the  unhappy  condition  of  the  insane  in  Ireland, 
and  the  important  Act  i  and  2  George  IV.  was  passed  in 
1821.  Lunatics  at  that  time  were  not  provided  for  except 
by  laws  that  were  measures  of  police  and  public  safety.  In 
the  report  of  a  governmental  commission  the  legal  status  of 
the  mentally  diseased  was  set  forth  in  the  following  lan- 
guage :  "  Lunacy  was  treated  as  a  crime,  and  the  lunatic 
as  though  he  was  a  malefactor,  not  merely  supposed  to  have 
committed  a  crime,  but  assumed  to  have  been  convicted  of 
it."  The  result  of  all  legislation  before  1821  was  character- 
ized by  a  committee  of  the  House  of  Lords  in  1843  ^^  a 
"distressing  example  of  human  suffering,  mistaken  legisla- 
tion, and  of  objectionable  practice."  Large  numbers  of  the 
insane,  for  lack  of  other  accommodation,  were  confined  in 
the  various  jails  of  the  country. 

The  Act  of  1 82 1  empowered  the  Lord-Lieutenant  to  form 


DISTRICT  ASYLUMS.  1/5 

districts,  to  direct  the  building  of  a  sufficient  number  of  asy- 
lums, and  when  built  to  appoint  governors  of  these  asylums. 
The  measure  further  provided  for  the  establishment  of  a 
Board  of  Control  who  were  vested  with  extensive  powers 
respecting  the  building  and  management  of  asylums.  They 
were  finally,  with  the  concurrence  of  the  Privy  Council,  em- 
powered to  frame  rules  for  conducting  such  institutions. 
With  some  alterations  and  amendments  this  Act  forms  the 
existing  system  of  Irish  lunacy  administration. 

There  were  erected,  under  the  Act  of  182 1,  nine  new  asy- 
lums, for  which  the  sum  of  iJ^2 10,000  was  advanced  by  Gov- 
ernment, and  which  was  to  be  repaid  by  instalments  extending 
over  a  series  of  years,  the  money  bearing  no  interest.  The 
total  cost  of  the  ten  district  lunatic  asylums  which  had  been 
built  before  1835,  amounted  to  ^^332, 207.  These  provided 
for  1,837  beds,  at  upwards  of  $876  per  bed. 

From  1843  to  1857  the  number  of  lunatic  asylums  in- 
creased from  ten  to  sixteen.  The  six  new  buildings,  accom- 
modating 1,760  patients,  were  erected  at  a  cost  of  ^261,995, 
or  about  $720  per  bed.  The  largest  of  these,  that  of  Cork, 
was  built  to  accommodate  500  patients,  at  a  cost  of  about 
$773  V^^  bed.  A  Royal  Commission,  appointed  in  1857,  re- 
ported that  the  district  asylums  were  to  a  great  extent 
deprived  of  their  utility  as  curative  hospitals  for  the  insane, 
on  account  of  the  large  number  of  chronic  cases  which  they 
contained,  and  recommended  that  other  and  separate  provis- 
ion be  made  for  the  latter  class. 

From  1866  to  1869,  six  additional  asylums  were  erected 
at  a  total  cost  of  ^292,155,  giving  accommodation  for  1,769 
patients.  This  outlay,  as  will  be  seen,  was  at  the  rate  of 
nearly  $800  per  bed,  but  it  was  not  made  in  compliance 
with  the  recommendation  of  the  Commission,  the  new 
asylums   having  been   expensively  built   as   curative   estab- 


176  IRELAND. 

lishments,  thus  leaving  the  country  as  before  without  any- 
special  or  separate  provision  for  patients  of  the  probably 
incurable  or  chronic  class.  A  Commission  of  Inquiry  in 
1879,  after  full  investigation,  recommended,  inter  alia, 
that  a  certain  number  of  the  district  asylums  should 
be  set  apart  for  curative  treatment,  and  that  the  other 
district  asylums  should  receive  chronic  cases  requiring 
special  care.  The  Commission  further  recommended  that 
the  inspection  of  "  lunatics  at  large,"  instead  of  being  left 
to  the  constabulary,  should  be  undertaken  by  dispensary 
district  medical  ofificcrs,  acting  under  the  lunacy  authorities. 
The  fact  of  upwards  of  6,000  lunatics  living  "  at  large  " 
among  friends  and  relatives  throughout  the  country,  with  no 
other  ofificial  oversight  than  that  of  constables  who  collected 
statistics  respecting  them  and  who  were  guided,  in  a  great 
measure,  by  the  gossip  of  the  place,  was  deemed  by  the 
Commission  to  be  a  serious  blot  on  the  lunacy  system. 

The  estimated  population  of  Ireland  on  the  29th  of  Sep- 
tember, 1886,  was  4,889,430.  The  number  of  lunatics  in- 
cluding idiots  under  supervision  of  the  Inspectors  of  Lunacy 
January  i,  1887,  was  14,702,  being  one  to  every  333  of  the 
population.  According  to  the  last  census  (1881),  the  popu- 
lation was  5,159,839.  The  number  of  lunatics  under  the 
supervision  of  the  Inspectors  at  this  time  was  13,444,  being 
one  to  every  384  of  the  population.  It  will  be  observed  that 
these  figures  show  a  considerable  decrease  in  population  and 
an  increase  in  the  number  of  lunatics.' 

The  distribution  of  lunatics  under  the  supervision  of  the 
Inspectors  of  Lunacy  on  the  1st  of  January,  1887,  was  as 
follows  :   In  the  twenty-two  district  or  public  asylums  there 

'  The  statistics  given  here  as  well  as  those  in  the  chapters  on  England  and 
Scotland,  include  only  such  lunatics  as  come  under  the  cognizance  of  the  lu- 
nacy commissioners  and  inspectors.  This  fact  should  be  kept  in  mind  in  con- 
sidering the  ratio  of  lunatics  to  population. 


MAINTENANCE  AND  ACCOMMODATION.  1 77 

were  10,077,  ^^  whom  only  a  few  were  paying  patients  ;  in 
the  poorhouses  (workhouses)  scattered  over  the  country 
there  were  3,841  ;  in  private  asylums  611  ;  in  the  criminal 
lunatic  asylum  at  Dundrum  172  ;  and  in  jail  i.  It  was  esti- 
mated that  7,779  of  the  insane  in  district  asylums  were  of  the 
incurable  class  and  that  about  half  of  the  lunatics  in  the 
poorhouses  were  idiots,  epileptics,  and  confirmed  imbeciles. 

The  average  weekly  per-capita  cost  of  maintenance  in  dis- 
trict asylums  during  the  year  ending  January  i,  1887,  was 
8.y.  \d.,  of  which  four  shillings  was  paid  by  the  Government. 
The  total  amount  of  the  Government  grant  for  that  year 
was  ;^ 99,608,  16^.  In  cost  of  maintenance  are  included  sala- 
ries and  wages,  provisions,  clothing,  bedding,  furniture, 
household  supplies,  medicines,  incidental  expenses,  "  super- 
annuations," and  repairs  and  alterations.  In  poorhouses 
where  not  more  than  a  bare  existence  is  maintained,  the  In- 
spectors estimate  that  the  weekly  per-capita  cost  of  support- 
ing the  lunatic  poor  may  be  set  down  at  4^-.  ^\d. 

The  provision  for  chronic  cases  in  Ireland  is  still  inade- 
quate, and  hence  we  find  more  than  one  fourth  of  the  regis- 
tered pauper  insane  restricted  to  the  unsatisfactory  accom- 
modations of  the  poorhouses.  The  Inspectors  of  Lunacy, 
though  strongly  opposing  the  common  care  of  insane  and 
other  dependents,  advise,  as  an  expedient  to  meet  existing 
emergencies,  that  in  each  asylum  district  a  poorhouse  be 
selected  in  a  central  position,  with  land  attached,  to  which 
tranquil  and  utterly  hopeless  cases  could  be  removed  and 
separately  cared  for.  Lunatics  in  poorhouses  are  only  in  a 
minor  degree  under  the  control  of  the  Inspectors,  the  poor- 
houses coming  under  the  authority  of  the  Local  Government 
Board  for  Ireland,  which  is  the  central  poor-law  authority. 
The  Inspectors  of  Lunacy  cannot  alter  the  poorhouse  dietary, 
nor  can  they  order  that  paid  attendants  be  provided  for  the 


178  IRELAND. 

insane,  though  they  may  direct  the  removal  of  a  pauper 
lunatic  from  the  poorhouse  to  an  asylum,  should  they  deem 
such  removal  necessary.  The  Local  Government  Board  has 
always  opposed  the  conversion,  on  any  large  scale,  of  poor- 
houses  into  receptacles  for  the  insane,  on  the  ground  that 
this  was  never  contemplated  by  the  poor-law,  which  was 
framed  only  with  reference  to  the  relief  of  the  sane  poor. 

From  an  examination  made  of  a  considerable  number  of 
poorhouses  in  different  parts  of  Ireland,  the  writer  was  con- 
vinced that  the  provision  therein  for  the  insane  was  in 
almost  every  respect  unsuitable.  The  patients  occupied 
cramped  spaces  with  imperfect  ventilation  and  without  the 
usual  asylum  accessories,  and  there  was  little  or  no  oppor- 
tunity for  employment  or  recreation. 

There  are  twenty-three  private  asylums  and  licensed  es- 
tablishments. Some  of  these  are  charitable  institutions 
supported  wholly  or  in  part  by  voluntary  contributions,  and 
others  are  kept  by  their  proprietors  for  profit.  Among 
those  specially  worthy  of  note  are  St.  Patrick's  Hospital, 
founded  by  Dean  Swift  ;  the  Retreat,  directed  by  the  Soci- 
ety of  Friends;  the  Stewart  Institution  ;  the  Hospice  of  St. 
Vincent  de  Paul  for  females,  which  is  under  the  immediate 
charge  of  a  religious  sisterhood  ;  and  two  establishments  for 
men,  which  are  conducted  by  religious  fraternities — one 
French  and  the  other  Belgian. 

The  Board  of  Control,  created  by  the  Act  I  and  2  George 
IV.,  has  its  office  in  Dublin  Castle.  It  consists  of  five  com- 
missioners, three  of  whom  are  commissioners  of  Public 
Works.  Two,  who  are  physicians,  are  the  Inspectors  of 
lunatic  asylums.  The  five  are  joint  trustees  of  the  property 
of  district  asylums.  The  powers  of  the  Board  pertain  more 
immediately  to  the  purchasing  of  land,  the  erection  and 
establishment  generally  of  district  asylums,  and  the  furnish- 


S  UPER  VISION.  1 79 

ing  of  them.  The  outlay  made  under  the  sanction  of  this 
department  since  1830  has  been  about  $7,250,000.  Sub- 
ordinate to  the  commissioners  are  a  secretary,  an  architect, 
accountant,  and  a  solicitor.  The  two  Inspectors,  with  their 
assisting  clerks,  have  also  an  office  in  Dublin  Castle.  Upon 
the  Inspectors  practically  devolves  the  entire  work  of  visita- 
tion and  supervision  of  all  the  lunatic  asylums  in  Ireland. 
They  visit  each  of  the  public  and  private  asylums  four  times 
a  year,  besides  making  special  visits  to  them  when  necessary. 
Their  inspections  also  extend  to  the  one  hundred  and  sixty- 
two  poorhouses  in  different  parts  of  the  country.  The  In- 
spectors make  an  annual  report  to  the  Lord-Lieutenant, 
for  presentation  to  Parliament. 

The  boards  of  governors  of  district  asylums  appointed  by 
the  Lord-Lieutenant  from  among  prominent  citizens,  are 
similar  in  many  respects  to  the  visiting  committees  appoint- 
ed by  justices  in  England,  and  like  them  serve  gratuitously. 
The  boards  of  governors  supervise  the  financial  affairs  of  the 
asylums  to  which  they  are  appointed,  and  hold  monthly 
meetings  for  this  purpose. 

Among  the  points  wherein  the  Irish  lunacy  system 
differs  from  the  English,  the  following  may  be  noted : 
The  resident  medical  superintendent  of  an  asylum  in  Ire- 
land is  appointed  by  the  Lord-Lieutenant,  and  discharges 
the  duties  of  his  office  in  conformity  with  Privy  Council 
rules.  There  is  also  a  visiting  physician  attached  to  each 
asylum,  who  is  appointed  by  the  Board  of  Governors.  He 
visits  daily  the  convalescent  cases,  and  signs  jointly  with  the 
resident  physician  certificates  of  discharge.  An  anomaly  is 
found  in  magistrates  possessing  the  power  to  license  private 
asylums  or  licensed  houses,  but  having  no  authority  to  sus- 
pend the  licenses,  the  latter  power  being  vested  in  the  In- 
spectors ;  while  the  Inspectors,  not  having  any  voice  in  the 


l8o  IRELAND. 

granting  of  licenses,  rarely  meddle  with  what  has  been  done 
by  the  magistrates.  Then,  with  regard  to  pauper  lunatics, 
the  relieving  officer  is  not  called  upon,  as  in  England,  to  re- 
port to  the  medical  officer  of  his  district  the  existence 
therein  of  lunatics  or  idiots  unless  they  become  a  charge  on 
the  rates.  No  law  of  settlement  prevails,  and  the  place  of 
commitment  must  bear  the  cost  of  maintenance.  In  the 
event  of  his  being  convicted  of  some  trivial  offence,  a  pauper 
or  other  lunatic  may,  under  a  recent  statute,  be  confined  as 
a  dangerous  lunatic. 

While  the  law  is  similar  to  that  of  England  as  regards 
chancery  and  private  lunatics  possessed  of  property,  there  is 
a  considerable  difference  as  regards  pauper  or  even  paying 
patients  of  the  middle  class  seeking  admission  into  public 
or  district  asylums.  As  already  indicated,  nearly  all  of  the 
patients  in  the  twenty-two  district  asylums  are  paupers. 
One  of  the  regulations  made  by  the  Privy  Council  was  that 
no  paying  patient  should  be  admitted  into  any  district  luna- 
tic asylum  so  long  as  there  should  be  unsatisfied  the  appli- 
cation of  any  pauper  lunatic. 

Most  of  the  patients  in  public  asylums  are  admitted  in 
one  of  three  ways,  as  follows  :  First,  by  application  of  the 
friends  of  a  lunatic,  addressed  to  the  local  board  of  govern- 
ors, and  accompanied  by  a  medical  certificate,  and  a  certifi- 
cate of  identification  from  a  clergyman  or  magistrate  stating 
that  the  person  to  be  committed  has  not  means  sufficient  to 
support  him  in  a  private  asylum  ;  second,  in  cases  of  urgency 
the  resident  physician  of  an  asylum  may  satisfy  himself  of 
the  condition  of  the  patient  and  admit  on  the  bare  certificate 
of  a  medical  man,  subject  to  the  approval  of  the  governors 
at  their  next  meeting  ;  third,  by  the  signed  order  of  two 
magistrates,  which  is  accompanied  by  a  medical  certificate. 
In  the  admission  of  patients  to  private  asylums,  two  medical 


COMMITTAL  B  V  MA  GISTRA  TES.  1 8 1 

certificates  and  the  signed  order  of  a  relative  or   friend  are 
necessary. 

The  procedure  of  commitment  and  manner  of  conveying 
patients  to  asylums  are  open  to  grave  objections,  especially 
in  the  case  of  so-called  "  dangerous  lunatics"  committed  by 
magistrates.  During  the  year  ending  January  i,  1887,  sixty- 
six  per  cent  of  the  2,746  insane  received  into  district  asylums 
were  admitted  in  this  manner.  As  bearing  upon  this  sub- 
ject, the  Inspectors  say  : 

"  Owing  to  the  hasty  procedure  too  frequently  adopted,  scanty 
information,  occasionally  none  whatever,  is  supplied  on  the  face 
of  the  warrants,  beyond  the  offence  committed,  or  the  assumption 
of  an  intention  by  an  irresponsible  agent,  such  as  the  breaking  of 
a  pane  of  glass,  jumping  into  a  pool  of  water,  or  threatening  to 
do  violence.  This  mode  of  peopling  an  asylum,  however  benev- 
olently intended,  is  upheld  by  magistrates  at  Petty  Sessions,  who 
frequently  have  no  evidence  before  them  beyond  the  declaration 
of  parties  anxious  to  get  rid  of  troublesome  relatives,  and  the 
opinion  of  physicians  casually  called  in  by  them  to  cases  with 
which  they  may  have  been  unacquainted.  Thus  not  only  no 
reliable  information  is  supplied  for  the  guidance  of  an  asylum 
physician,  but  utter  strangers  are  occasionally  made  chargeable 
to  districts  with  which  they  have  had  no  previous  connection. 
Independent,  too,  of  an  unfair  local  taxation,  it  often  occurs  that 
'dangerous  lunatics,'  male  and  female,  young  and  old  alike,  have 
to  be  conveyed  from  distances  extending  to  seventy  or  eighty 
miles,  some,  mayhap,  handcuffed,  under  a  police  escort,  to  their 
destination.  The  statute  further  leads  to  abuse  from  magisterial 
oversight ;  scarcely  a  week  passes  over  without  illegal  commit- 
tals, and  the  consequent  necessity  of  our  returning  them  to  the 
committing  justices  for  rectification." 

The  discharge  of  patients  from  district  asylums  rests  with 
the  board  of  governors,  who  usually  act  upon  the  recom- 
mendation of  the  superintendent.  The  Inspectors  are  also 
vested  with  the  power  to  order  discharge. 

Connected  with  Irish  asylums  are  but  small  areas  of  land 


1 82  IRELAND. 

for  tillage  and  pasture,  consequently  there  is  a  lack  of  some 
farm  products  which  are  nutritious  and  highly  beneficial  to 
the  insane.  Especially  is  this  true  of  milk,  large  quantities 
of  which  are  required  in  institutions  of  this  kind.  Besides, 
from  the  insufificiency  of  land  there  is  not  as  much  outdoor 
employment  as  is  desirable.  Within  doors,  in  addition  to 
the  usual  trades  carried  on  by  men,  such  as  shoemaking, 
tailoring,  carpentering,  etc.,  basket-making  has  been  under- 
taken in  a  few  asylums. 

Notwithstanding  the  defects  in  the  Irish  lunacy  laws,  it 
must  be  conceded  that  the  administration  of  the  affairs  of 
the  existing  institutions  are  generally  deserving  of  commen- 
dation. The  superintendents  are  efficient,  and  manifest  an 
earnest  interest  which  extends  to  every  detail  of  their  work. 
A  few  extracts  from  my  notes  of  visitation  will  suffice  to  indi- 
cate the  general  character  of  the  insane  asylums  of  Ireland. 

CORK    DISTRICT    LUNATIC   ASYLUM. 

This  institution  is  so  situated  as  to  overlook  a  broad 
expanse  of  the  fertile  valley  of  the  Lee,  and  is  sur- 
rounded by  well-kept  grounds  ornamented  with  flowers  and 
shrubbery.  The  asylum  is  designed  for  the  insane  poor  of 
the  district  of  Cork,  and  has  accommodation  for  nine  hun- 
dred and  thirty  patients.  It  is  built  in  a  semi-Gothic  style 
on  the  congregate  plan.  The  four-story  central  depart- 
ment has  three-story  wings  to  the  right  and  left,  the  whole 
presenting  an  extended  front  broken  by  gables. 

The  financial  affairs  of  the  institution  are  directed  by  a 
Board  of  Governors  composed  of  forty  members.  They  hold 
monthly  meetings,  the  average  attendance  at  which  is  about 
ten.  The  asylum  is  under  the  immediate  charge  of  a  resi- 
dent medical  superintendent  aided  by  two  medical  assist- 
ants.    There   are    also   a    regularly  appointed   visiting   and 


CORK  ASYLUM.  1 83 

consulting  physician,  an  oculist,  and  a  dentist.  Included  in 
the  house  staff  are  a  clerk  and  his  assistant,  a  matron,  house- 
steward,  storekeeper,  band-master,  librarian,  and  a  fire- 
brigade  instructor. 

Aside  from  single  rooms  there  are  various  associated  dor- 
mitories accommodating  from  four  to  twenty  patients  each. 
A  preference  was  shown  for  the  latter,  about  two  thirds  of 
the  inmates  being  provided  for  in  this  way.  The  bedsteads 
are  made  of  gas-pipe.  Strong  canvas,  with  eyelet-holes 
around  the  margins,  is  laced  to  the  frame-work,  and  forms  a 
bottom  to  the  bed.  This  arrangement,  facilitating  easy 
removal  and  cleansing,  and  thereby  affording  precautions 
against  vermin,  was  claimed  to  have  other  advantages. 
Through  the  centre  of  some  of  the  large  dormitories  is  a 
partition  with  short  cross-sections  forming  two  rows  of 
stalls  for  beds.  The  partitions  are  four  and  a  half  feet 
high,  and  have  an  open  space  beneath.  The  windows  have 
light  iron  sashes,  so  adjusted  that  the  upper  and  lower  parts 
can  be  simultaneously  moved  to  the  extent  of  four  inches. 
On  some  of  the  floors  was  laid  bright-bordered  oil-cloth  or 
linoleum.  Large  open  fire-places  were  mainly  relied  upon 
for  warmth  and  ventilation. 

The  men  and  women  have  their  meals  together  in  a  spa- 
cious dining-hall  designed  to  accommodate  seven  hundred 
persons.  This  is  also  used  as  an  amusement  hall,  and  it  has 
a  gallery  for  the  band. 

From  the  several  airing-courts  at  the  rear  of  the  building 
one  has  a  view  of  the  asylum  and  grounds  and  of  the  beauti- 
ful valley  beyond.  The  walls  of  the  court  for  men  are  built 
higher  at  one  of  the  corners  for  ball-playing,  which  is  here  a 
favorite  pastime.  The  yards  for  women  were  made  attract- 
ive by  beds  of  flowers,  plots  of  greensward,  and  gravelled 
walks. 


1 84  IRELAND. 

The  land  connected  with  the  asylum  is  limited  to  fifty- 
seven  acres,  only  thirty-two  of  which  are  used  for  farm  and 
garden  purposes,  the  remainder  being  taken  up  by  buildings, 
yards,  and  groves.  Seventy-four  of  the  men  were  engaged  in 
the  cultivation  of  the  ground,  mostly  by  the  use  of  the 
spade.  During  the  year  preceding  my  visit  there  were,  on 
an  average,  forty-six  per  cent  of  the  patients  usefully 
employed. 

It  was  said  that  very  little  restraint  was  resorted  to.  Four 
rooms  were  padded,  both  walls  and  flooring,  and  in  these 
very  excitable  patients  were  occasionally  placed.  The  in- 
terior construction  of  these  rooms  is  designed  to  obviate  the 
possibility  of  self-injury.  Cribs  were  not  in  use.  There 
were,  however,  box-beds  in  which  patients  were  sometimes 
tied.     The  bathing  arrangements  include  a  Turkish  bath. 

Connected  with  the  institution  are  two  chaplains — one  of 
the  Roman  Catholic  Church,  and  the  other  of  the  Church  of 
Ireland.  During  the  early  part  of  1886,  a  chapel  for  the 
Protestant  inmates  was  completed  and  opened  for  religious 
services.  It  is  a  Gothic  structure  having  colored  glass  win- 
dows, and  a  tower  with  a  bell.  The  grounds  about  the 
edifice  have  been  graded,  planted,  and  otherwise  improved 
by  the  aid  of  the  inmates. 

The  number  of  patients  January  i,  1887,  was  476  males, 
and  449  females. 

Brief  as  it  was,  my  visit  to  this  institution  proved  an 
agreeable  introduction  to  Irish  asylums.  As  I  left  the  place, 
the  sight  presented  was  particularly  pleasing.  The  patients 
were  out  on  the  broad  and  elevated  terrace,  evidently  enjoy- 
ing the  fine  music  of  a  band  composed  of  asylum  attendants. 

BELP^AST    DISTRICT    LUNATIC   ASYLUM. 

The  inmates  of  this  asylum,  as  in  most  similar  institutions 
in  Ireland,  are  principally  of  the  dependent  class.     Here,  as 


BELFAST LETTERKENNY.  1 85 

elsewhere,  the  asylum,  though  primarily  designed  as  a  cura- 
tive hospital,  was  overcrowded  and  heavily  burdened  with 
chronic  cases. 

The  buildings  are  plain,  substantial  brick  structures  two 
and  three  stories  high,  and  have  pleasant  grounds  in  front. 
The  asylum  estate,  containing  fifty-five  and  a  half  acres,  is 
inclosed  by  a  wall.  The  buildings,  courts,  and  recreation 
grounds  take  up  thirteen  and  a  half  acres. 

On  the  male  side  are  sixty  single  rooms.  Of  the  associated 
dormitories,  ten  accommodate  four  patients  each  ;  and  eight, 
sixteen  patients  each.  The  arrangements  for  women  are 
substantially  the  same  as  those  for  men.  The  bedsteads 
are  of  iron  with  strap  bottoms,  over  each  of  which  is 
placed  a  thick  straw  mat  that  protects  the  mattress.  At 
the  foot  of  each  bed  was  a  semi-circular  willow  basket  for 
the  clothes  of  the  patient.  Special  provision  is  made  for 
epileptics.  A  night-watch  perambulates  the  building,  and 
makes  hourly  visits  to  the  patients. 

In  a  large  dining-hall,  men  and  women  sat  at  separate 
tables.     There  were  guards  to  the  open  fire-places. 

The  employments  for  men  include  garden  and  other  out- 
door work,  shoemaking,  carpentering,  painting,  and  tailoring ; 
for  women,  needlework,  knitting,  laundry-work,  and  house- 
cleaning. 

The  airing-courts  are  spacious.  On  the  men's  side  accom- 
modation for  playing  ball  is  provided  on  the  plan  already 
referred  to  at  Cork.  At  their  amusements,  and  in  their  several 
occupations,  the  insane  are  under  watchful  supervision.  Here, 
as  at  Cork,  a  band  composed  mainly  of  attendants  played  at 
certain  hours,  for  the  entertainment  of  the  inmates. 

DONEGAL   DISTRICT    LUNATIC  ASYLUM — LETTERKENNY. 

The  above  asylum,  principally  occupied  by  insane  poor,  is 
pleasantly   situated  in  the  wild  and  picturesque  county  of 


1 86  IRELAND. 

Donegal.  At  the  time  of  my  visit,  it  contained  298  inmates 
under  the  care  of  Dr.  Joseph  Petit,  aided  by  thirty-two 
subordinate  officers,  attendants,  and  servants.  Since  then 
the  number  of  patients  has  slightly  increased,  there  being 
324  inmates  on  the  ist  of  January,  .1887.  Only  no  of  these 
were  women. 

Passing  the  gateway  lodge,  which  is  kept  by  a  patient,  one 
reaches  a  block  of  plain  yet  commodious  buildings  fronted 
by  a  broad  green  lawn,  and  commanding  an  extensive  view. 
The  buildings,  though  not  imposing,  are  pleasingly  varied  in 
outline,  and  are  constructed  so  as  to  afford  the  inmates  the 
maximum  of  sunlight. 

There  are  eighty-six  single  rooms,  six  rooms  accommo- 
dating three  each,  and  ten  associated  dormitories  containing 
each  from  ten  to  thirty  beds.  The  floors  were  covered  with 
manilla  matting.  Willow  baskets  for  patients'  clothes  hung 
at  the  foot  of  the  bedsteads.  The  windows  had  iron  sashes 
only  in  the  single  rooms.  The  Superintendent  favored 
windows  constructed  so  as  to  enable  the  patient  when  seated 
to  obtain  outside  views.  Open  fire-places  were  noticed 
in  all  the  principal  rooms  of  the  building.  The  ventilation 
appeared   to  be  good. 

It  was  stated  that  restraint  is  reduced  to  the  minimum 
in  this  institution.  There  were  no  patients  in  seclusion  at 
the  date  of  my  visit.  From  the  airing-courts,  a  fine  view 
of  the  adjacent  country  is  obtained.  Dr.  Petit  advocated 
the  total  abolition  of  walls,  which  he  considered  not  only 
unnecessary  if  there  was  proper  supervision,  but  positively 
injurious  to  the  patient.  He  further  maintained  that  free- 
dom had  a  salutary  influence  on  attendants,  stimulating 
them  to  greater  attention  to  duty. 

In  the  way  of  industries,  many  of  the  men  were  employed 
on    the    farm,    others    at    tailoring,   shoemaking,   etc.     The 


RICHMOND  ASYLUM.  1 8/ 

women  were,  for  the  most   part,   engaged  in   sewing   and 
housework. 

It  was  evident,  from  an  inspection  of  the  whole  institu- 
tion, that  it  was  under  good  administration. 

RICHMOND   DISTRICT   LUNATIC    ASYLUM — DUBLIN. 

This  is  the  oldest  of  the  Irish  public  asylums,  and  in  its 
management  ranks  among  the  foremost  institutions  of  its 
kind  in  either  Ireland  or  Great  Britain.  For  thirty  years  it 
was  under  the  superintendence  of  Dr.  Joseph  Lalor,  to  whom 
it  is  greatly  indebted  for  its  present  advanced  position.  At 
the  time  of  my  visit  Dr.  Lalor  was  assisted  by  two  medical 
officers.  There  were  also  a  consulting  and  visiting  physician 
and  a  surgeon.  The  attendants  on  the  men's  side  numbered 
forty-six  and  on  the  women's  side  fifty-four.  The  patients, 
of  whom  there  was  a  slight  excess  of  women  over  men,  num- 
bered about  one  thousand.  There  were  only  a  very  few 
paying  patients,  who  were  received  at  a  low  charge  for 
maintenance.  Among  the  inmates  was  a  considerable  num- 
ber of  feeble-minded,  on  whose  educational  training  much 
attention  was  bestowed.  The  asylum,  situated  in  the  midst 
of  well-arranged  grounds,  is  an  old-fashioned  structure  on 
the  congregate  plan. 

On  entering  the  spacious  dining-hall,  used  also  as  a  place 
of  entertainment,  one  sees  conspicuously  placed  upon  the 
wall  the  good  old  Celtic  motto — "  Cead  Mile  Failte  "  (a 
hundred  thousand  welcomes.)  There  were  here  many 
evergreen  wreaths  left  over  from  the  holidays,  which  lent 
quite  a  festive  appearance  to  the  interior.  Before  eating, 
grace  was  sung  to  an  organ  accompaniment.  The  table 
furnishing  consisted  of  an  ample  supply  of  crockery,  knives 
with  blunt  points,  and  forks  with  short  prongs.  The  food 
was  wholesome,  but  there  was  little  variety. 


1 88  IRELAND. 

The  associated  dormitories  are  large  and  airy,  while  many 
of  the  single  rooms  were  each  found  to  afford  1,200  cubic 
feet  of  air  space.  The  mattresses  were  uncovered  and  the 
bedding  folded  and  laid  upon  them  for  convenient  inspec- 
tion. The  ordinary  sheeting  was  of  strong  Irish  linen. 
Epileptic  patients  sleep  in  deep  box  bedsteads.  Two  nurses 
are  on  duty  at  night  in  each  of  the  large  dormitories,  and 
two  are  specially  charged  with  the  oversight  of  epileptics. 
The  night  watch  is  checked  by  tell-tale  clocks.  The  rooms 
for  seclusion  were  padded  with  cocoa  fibre,  and  the  edges 
of  the  floor  matting  were  bound  with  leather.  In  many 
of  the  day-rooms,  a  strip  of  wood  was  fastened  round  the 
margin  of  the  floor  to  prevent  the  furniture  from  being 
pushed  against  the  wall.  Papier-mache  basins  were  pro- 
vided for  violent  patients. 

In  the  day-rooms  for  women  there  were  many  flowers  in 
hanging-baskets  before  the  windows.  The  rooms  were 
cheerful,  and  comfortably  furnished.  From  the  furniture  all 
angular  corners  were  rounded  off  to  prevent  injury  to  the 
patients.  The  chairs  were  of  strong  hard  wood.  Birds  in 
cages  were  noticed  in  all  the  day-rooms  of  the  institution. 
In  the  departments  for  hysterical  patients  and  those  suffer- 
ing from  melancholia,  there  were  numerous  pictures  and 
many  other  objects  varying  in  form  and  color,  to  attract 
and  interest  the  inmates.  The  windows  are  so  constructed 
as  to  open  simultaneously  at  the  top  and  bottom.  Some  of 
the  windows  have  iron  sashes.  In  all  the  wards  were  seen 
open  fire-places. 

Respecting  the  efficacy  of  employment  and  training  as  aids 
to  the  recovery  of  persons  suffering  from  mental  disorder, 
Dr.  Lalor  said  :  "  Employment  of  some  kind  is  the  agent  to 
which  we  should  look  for  the  improvement  and  cure  of  the 
insane."     He  has  been  designated  "  the  father  of  the  school 


RICHMOND    ASYLUM.  1 89 

system  as  applied  to  asylums."  In  this  connection  it  should 
be  mentioned  that,  in  addition  to  other  employees,  there 
are  two  male  and  three  female  school  teachers,  whose 
duty  it  is  to  instruct  patients  in  the  ordinary  rudimentary 
branches  and  in  music  and  drawing.  There  are  besides  ten 
"  school  attendants  "  who  are  employed  as  ordinary  attend- 
ants, but  who,  during  school  hours,  assist  in  school  work. 
For  the  performance  of  these  duties  such  persons  are 
selected  as  have  had  experience  as  teachers  and  who,  as  Dr. 
Lalor  expresses  it,  have  thus  acquired  the  habit  of  exercis- 
ing a  mastery  over  the  mind,  and  a  practical  knowledge  of 
regulating  the  habits  and  conduct  which  teaching  confers — 
advantages  which  not  only  come  in  play  during  school 
hours,  but  in  the  general  management  of  the  institution. 
The  main  objects  kept  in  view  here  are  to  provide  varied 
occupations  for  as  many  as  are  able  to  work  ;  to  apply  a 
system  of  education  that  will  divert  and  strengthen  the 
mind  ;  and  to  promote,  by  every  conceivable  means,  the 
happiness  and  welfare  of  the  inmates.  During  the  year 
preceding  my  visit  no  fewer  than  470  men  and  467 
women  patients  had  attended  the  several  classes.  The 
school  is  a  kind  of  kindergarten.  There  are  lessons  on 
color,  subjects  in  natural  history  are  illustrated  by  pictures 
or  real  objects,  and,  in  general,  material  things  are  used  to 
develop  ideas.  The  school  is  conducted  in  three  divisions  for 
each  sex,  and  these  arc  subdivided  into  six  classes  for  males 
and  five  for  females.  Fifteen  minutes  at  the  opening  are 
given  to  an  "  inspection  as  to  cleanliness."  The  lessons  are 
brief,  and  there  are  frequent  physical  exercises  and  singing, 
with  intervals  of  outdoor  and  indoor  recreation.  The 
course  of  instruction  is  varied  so  as  to  constantly  occupy 
the  mind  and  form  an  agreeable  routine  for  the  whole  day, 
and  the  exercises  of  different  days  are  unlike.     The  follow- 


190 


IRELAND. 


ing  table  shows  to  what  extent  the  school  system  obtains  in 
this  asylum,  and  partly  indicates  how  the  time  of  the  patients 
is  occupied  during  a  year: 


Occupation  of  Time. 


Average  number 
of  patients. 


Highest  number 
during  the  year. 


Reading 

"Writing  on  Slates 

"        on  Copies,  from  Books  or  Head- 
Lines 

' '        from  Dictation 

Grammar,  Parts  of  Speech 

"  Parsing  and  Derivations 

Geography,  Local  and  Descriptive 

"  Physical  and  Historical 

Natural  History,  with  Illustrations 

Mechanical  Powers,  from   Models 

Arithmetic,  Notation  and  Simple  Rules.  . 

' '  from  Ball-Frames 

"  Compound  Rules 

"  Proportion  and  Interest 

Mental 

Drawing  Class 

Object  Lessons 

Marching  to  Music 

Physical  Exercises  and  Drill 

Mixed  Concert  (bi-weekly) 

Concerts  (fortnightly) 

Attending  Singing  Classes  daily 

Assist  in  Teaching 

Country  Walks  (weekly) 

Visiting  Zoological  and  Botanical  Gardens. 
Assist  in  Keeping  Accounts,  Record  of  Oc- 
cupation Tables,  and  Copying 

Attending  Review  on  Queen's  Birthday.  . 

Outdoor  Recreation  (daily) 

Attending  Religious  In-  \  M.        F. 

struction   in  their  Re-  '-  R.C.    80     141 
spective  Churches.  )  I.C.      18       29 


226 
40 

100 

175 
118 

30 
230 

30 
250 

55 

139 

43 

142 

30 

226 

40 

226 

190 

190 

36 

36 

54 

12 

90 


6 
132 

293 

(■98 


280 
200 

80 
120 
150 

24 
130 

36 
130 

146 

96 

36 

2 

60 

2 

120 

280 
20 
70 
30 

100 
12 
80 
35 


280 


170 


506 
240 

180 

295 
268 

54 
360 

66 
380 

55 
285 

139 

178 

32 
286 

42 
346 
470 
210 
106 

66 
154 

24 
170 

115 

7 
132 

573 
268 


258 
53 


122 

32 

236 

32 
256 

59 

145 

46 

147 

32 

258 

45 

258 

200 

200 

40 

40 

60 

14 

100 
80 


300 
120 


290 
220 

86 
130 
156 

30 
140 

38 
136 

150 

100 

40 

4 

66 

2 

130 

290 

24 

74 

33 

130 

14 

108 
42 


290 


548 
273 

206 
310 

278 

62 
376 

70 
392 

59 
295 
146 
187 

36 
324 

47 
388 
490 
224 
114 

73 
190 

28 
208 
122 


590 


320 


In  connection  with  the  asylum  are  but  fifty-four  acres  of 
land,  fourteen  of  which  are  taken  up  with  buildings,  yards, 
etc.  The  farm  for  the  men  and  the  laundry  for  the  women 
are  valuable  outlets  for  expending  the  superfluous  energy  of 
the  patients.  Most  of  the  washing  is  done  by  hand,  and 
the  garments  are  dried  in  the  open  air.     The  clothing  of 


RICHMOND    ASYLUM. 


iqi 


the  filthy  patients  is,  however,  washed  by  machinery  in  a 
special  department.  After  soaking  for  six  hours  in  large 
vats,  it  is  subjected  to  a  high  temperature  and  the  action  of 
chemicals.  The  following  returns  show  the  daily  average 
number  of  patients  employed  and  unemployed  for  a  year  : 


Male  employment. 

Number 
employed. 

Female  employment. 

Number 
employed. 

Attending  School  only. .  . 

Office  Work 

Garden  and  Farm  Labor. 

Shoemaking 

Carpentering 

Painting 

Tailoring 

Mattress  Making 

Mason-Work 

I43.7 
3-0 

123.2 
7-5 
7-1 
9.0 
7.6 
9.0 
4.4 
30 
1.4 

I.O 

17.0 
55-6 

6.2 

Attending  School  only.  .  . 

Assisting  in  Siores 

Assisting  in  Laundry 

Needlework 

Darning  and  Mending.  .  . 

Fancy  Work 

Learning    to    Sew,    Knit, 

and  Crochet 

Quilting  &  Machine  Work. 
Assisting  in  Kitchen  and 

Dining  Hall 

26. 

9- 

48. 

130. 

135- 
8. 

14. 
2. 

Smith-Work  and  Engine. 

Plumbing 

Sweeping  Chimneys 

Patients'  Dining  Hall  and 

Food  Van 

Cleaning  House 

18. 
69. 

20. 

Attending      Members     of 
Staff 

Total  Employed  Daily. 
Unemployed 

Total 

Attending     Members     of 
Staff 

479- 
80. 

3Q8.7 
54-3 

Total  Employed  Daily. 
Unemployed 

559- 

Total 

453.0 

Amusements,  books,  and  periodicals  are  provided  in  almost 
endless  variety.  The  following  list  indicates  some  of  the 
kinds  of  recreation  :  Billiards,  bagatelle,  backgammon,  cards, 
chess,  dominoes,  draughts.  Aunt  Sally,  happy  families,  pum- 
ble-chook,  counties  of  England,  conjuring,  music,  singing, 
archery,  racing  games,  snap,  cricket,  football,  lawn-tennis, 
skittles,  nine-pins,  walking  in  the  garden,  walks  to  Phcenix 
Park,  to  the  Zoological  and  Botanical  Gardens,  and  fortnightly 
parties.  The  number  habitually  taking  part  in  amusements, 
games,  and  reading  during  the  year  previous  to  my  visit  was 
400  male  and  490  female  patients.     In   one   of  the  wards, 


192  IRELAND. 

about  thirty  patients  were  seated  in  a  circle  round  an  organ, 
listening  with  rapt  attention  to  the  music.  Women  were 
sewing  under  a  trained  teacher  in  another  room.  Some  dis- 
played not  a  little  skill  in  making  artificial  flowers.  In  all 
of  the  departments  of  this  institution  there  appeared  an 
unusual  air  of  activity  without  disturbance.  There  was 
constantly  during  the  day  some  kind  of  amusement,  employ- 
ment, instruction,  recreation,  or  entertainment.  The  whole 
system  seemed  to  be  ingeniously  planned  to  attract  the 
attention  of  the  patients  and  turn  their  thoughts  from  them- 
selves, and  at  the  same  time  to  inculcate  habits  of  self- 
control. 

It  being  visitors'  day,  friends  were  seen  holding  free  con- 
verse with  the  patients.  There  is  a  rule  that  no  patient 
shall  be  seen  by  any  visitor  until  after  a  month's  residence 
in  the  asylum. 

In  this  large  institution,  there  were,  on  the  day  of  my 
visit,  only  one  man  and  one  woman  in  seclusion.  It  was 
said  that  the  refractory  are  confined  but  for  a  short  time. 
Dr.  Lalor  expressed  his  opinion  strongly  in  favor  of  the 
efficacy  of  sunlight  for  secluded  cases.  Patients  liable  to 
kick  others  wear  soft  shoes.  Violent  and  disturbed  women 
were,  for  the  most  part,  plainly  dressed  in  linsey-woolsey. 
In  the  refractory  division  some  of  the  patients  were  pick- 
ing cocoa  fibre  ;  others,  stuffing  and  tufting  mattresses.  In 
this  ward,  fire-guards  were  placed  in  front  of  the  fire-places. 
Among  the  women  outside,  some  were  seen  wearing  a 
crimson  turban-like  head-dress.  This  was  so  tastefully 
arranged  as  to  be  attractive;  nevertheless,  it  was  a  device 
humanely  designed  to  protect  epileptic  patients  from  acci- 
dental injury. 

The  bearing  of  the  attendants  appeared  to  be  kind  and 
considerate.    The  salaries  of  the  women  ranged  from  ^ii  to 


RICHMOND  ASYLUM.  1 93 

;^I5  per  annum,  with  clothing  and  food,  and  those  of  the 
men  from  £\%  to  £2^,  beginning  at  the  lower  figures  and 
increasing  to  the  maximum. 

On  the  grounds  are  two  churches — one  a  large  and  artis- 
tic structure  for  Roman  Catholics,  the  other  a  tasteful  build- 
ing for  those  belonging  to  the  Irish  Church.  For  each  of 
these  and  for  the  Presbyterian  inmates  there  is  a  regular 
chaplain. 

Not  content  with  discarding  old  methods  of  restraint.  Dr. 
Lalor  also  signalized  his  advent  in  this  institution  by  pulling 
down  all  the  interior  walls  of  the  yards  and  airing-courts. 
These  are  only  some  indications  of  the  various  ways  in 
which  the  asylum  management  was  greatly  improved  by  this 
distinguished  alienist  supported  by  an  enlightened  govern- 
ing Board. 

Since  my  visit  here,  this  eminent  philanthropist  and  true 
friend  of  the  insane  has  passed  from  the  field  of  his  useful 
and  successful  labors.  The  asylum  is  now  superintended 
by  Dr.  Conolly  Norman.  On  the  ist  of  January,  1887,  it 
contained  eleven  hundred  and  three  patients. 


CHAPTER  V. 

CONTINENTAL    COUNTRIES. 

TURNING  our  attention  to  the  insane  on  the  Conti- 
nent of  Europe,  previous  to  the  reforms  introduced 
in  the  latter  part  of  the  eighteenth  century,  we  find  that  this 
wretched  class  were  subjected,  if  possible,  to  even  greater 
cruelty  and  neglect  than  that  under  which  they  then  suf- 
fered in  the  British  Isles.  Harmless  lunatics  were  exposed 
to  severe  and  lawless  chastisement ;  the  troublesome,  when 
held  in  custody,  were  confined  in  unwholesome  prisons, 
where  they  were  sometimes  placed  under  the  charge  of 
criminals,  who,  with  whips  and  savage  dogs,  held  barbarous 
sway  over  the  helpless  objects  of  their  cruelty.  Chains  were 
considered  indispensable  ;  even  the  garrote  was  used  ;  while 
privation  and  uncleanness  were  characteristics  of  these  for- 
lorn places. 

Riel,  in  writing  of  the  German  asylums  in  1803,  said: 
"  They  are  madhouses,  not  merely  by  reason  of  their  in- 
mates, but  more  especially  because  they  are  the  very  oppo- 
site of  what  they  are  intended  to  be.  They  are  neither 
curative  institutions,  nor  such  asylums  for  the  incurable  as 
humanity  can  tolerate.  They  are  for  the  most  part  verit- 
able dens.  Has  man  so  little  respect  for  the  jewel  which 
makes  him  man,  or  so  little  love  for  his  neighbor  who  has 
lost  that  treasure,  that  he  cannot  extend  to  him  the  hand  of 
assistance  and  aid  in  regaining  it  ?  Some  of  these  recep- 
tacles are  attached  to  hospitals,  others  to  prisons  and  houses 

194 


FORMER  ABUSES  IN  FRANCE.  I95 

of  correction  ;  but  all  are  deficient  in  ventilation,  in  the 
facilities  for  recreation  ;  in  short,  they  are  wanting  in  all  the 
physical  and  moral  means  necessary  to  the  cure  of  their 
patients." 

In  1818  Esquirol  said  of  the  insane  in  France:  "  I  have 
seen  them  naked,  or  covered  with  rags ;  with  nothing  but  a 
layer  of  straw  to  protect  them  from  the  cold  dampness  of 
the  ground  on  which  they  lay.  They  were  kept  on  food  of 
the  coarsest  kind  ;  they  were  deprived  of  fresh  air  to  breathe, 
and  of  water  to  quench  their  thirst,  and  even  of  the  most 
necessary  things  of  life.  I  have  seen  them  given  up  to  the 
brutal  supervision  of  jailors.  I  have  seen  them  in  their 
narrow  cells,  filthy  and  unwholesome,  without  air  or  light, 
chained  in  such  dens  as  one  might  dislike  to  confine  fero- 
cious beasts  in." 

The  condition  of  the  insane  in  the  most  refined  and  luxu- 
rious of  European  capitals,  just  before  the  changes  efi^ected 
by  Pinel,  is  thus  described  by  Pariset :  "  In  spite  of  the 
reforms  attempted  under  the  most  humane  of  all  kings,  the 
hospitals  of  the  Capital  were  still  in  a  d*eplorable  state  of  bar- 
barity. The  one  which  presented  the  most  revolting  aspect 
was  the  institution  of  Bicetre.  Vice,  crime,  misfortune,  in- 
firmity, diseases  the  most  disgusting  and  the  most  unlike, 
were  there  confounded  under  one  common  service.  The 
buildings  were  unfit  for  human  habitation.  ]\Icn,  covered 
with  filth,  cowered  in  cells  of  stone,  narrow,  cold,  damp,  with- 
out air  or  light,  and  furnished  solely  with  a  straw  bed  that 
was  rarely  renewed,  and  which  soon  became  infectious, — 
frightful  dens  where  we  should  scruple  to  lodge  the  vilest 
animals.  The  insane  thrown  into  these  receptacles  were  at 
the  mercy  of  their  attendants,  and  these  attendants  were  con- 
victs from  prison.  The  unhappy  patients  were  loaded  with 
chains,  and  bound  like  galley  slaves.       Thus  delivered,  de- 


196  CONTINENTAL    COUNTRIES. 

fenceless,  to  the  wickedness  of  their  guardians,  they  served 
as  the  butts  for  insulting  raillery,  or  as  the  subjects  of  a 
brutality  so  much  the  more  blind,  as  it  was  the  more  gratui- 
tous. The  injustice  of  such  cruel  treatment  transported  them 
with  indignation  ;  while  despair  and  rage,  finishing  the  work 
with  their  troubled  reason,  forced  from  them  by  day  and  night 
cries  and  bowlings  that  rendered  yet  more  frightful  the 
clanking  of  their  irons.  Some  among  them  more  patient  or 
more  crafty  than  the  rest  showed  themselves  insensible  to 
so  many  outrages  ;  but  they  concealed  their  resentment  only 
to  gratify  it  the  more  fully.  They  watched  narrowly  the 
movements  of  their  tormentors,  and  surprising  them  in  an 
embarrassing  attitude,  they  dealt  them  blows  with  their 
chains  upon  the  head  or  the  stomach,  and  felled  them  dead 
at  their  feet.  Thus  was  there  ferocity  on  the  one  hand, 
murder  on  the  other. 

"  At  the  Salpetriere  were  received  only  such  as  had  under- 
gone treatment  at  Hotel  Dieu, — the  common  and  imperfect 
treatment  which  rendered  the  state  of  the  patients  more  diffi- 
cult and  dangerous.  To  restrain  their  fury,  they  were  crushed 
under  the  same  rigors,  or  rather  they  were  irritated  by  the 
same  sorts  of  violence.  Sometimes  enchained  naked  in  the 
almost  subterranean  cells,  worse  than  dungeons,  they  had 
their  feet  gnawed  by  rats,  or  frozen  by  the  winter's  cold. 
Thus  injured  on  all  sides,  their  embittered  hearts  breathed 
only  vengeance,  and  intoxicated  with  frenzy  like  the  bac- 
chantes, they  burned  to  tear  in  pieces  their  attendants,  or  to 
destroy  themselves  before  them."  The  reforms  effected  by 
Pinel  at  these  two  dismal  places  have  already  been  de- 
scribed. 

It  is  gratifying  to  every  lover  of  humanity  to  reflect  that 
over  the  entire  Continent  great  progress  has  been  made  in 
legislation    for    the    protection    of    the    insane.     Humane 


BELGIAN    CAGE. 


REFORMS.  197 

methods  have  displaced  cruel  treatment,  and  with  few  exl- 
ceptions  well-equipped  asylums  have  taken  the  place  of  cells 
and  dungeons  ;  the  private  religious  establishments,  useful 
in  their  day,  have  been  almost  entirely  superseded  by  public 
institutions  ;  while  advances  made  in  medical  science  are 
shown  in  the  greater  effectiveness  of  the  present  curative 
treatment  of  the  mentally  diseased.  The  first  asylum  in 
central  Europe  established  exclusively  for  the  insane  was 
opened  at  Vienna  so  recently  as  1784.  Curative  treatment 
as  the  primary  aim  of  institutions  for  the  insane  was  soon 
after  recognized  in  Germany,  and  improved  methods  of 
care  for  this  class  were  generally  adopted.  Among  the 
notable  reforms  of  recent  years  were  those  accomplished  in 
Belgium.  Following  an  ofificial  inquiry,  the  Government,  in 
1850,  made  radical  changes  in  its  laws  affecting  the  insane. 
It  virtually  reorganized  its  lunacy  system  and  abolished 
many  grave  abuses  that  had  previously  existed  in  that 
country.  Under  the  new  system  the  use  of  cribs  or  cages 
then  common  in  asylums  was  forbidden.  One  of  these 
peculiar  contrivances  for  confining  the  insane  was  on  exhi- 
bition at  the  National  Fair  held  at  Brussels  in  1880.  It 
was  a  sort  of  wooden  cage  on  short  posts,  into  which  the 
food  was  passed  through  a  small  opening  in  the  frame-work. 

It  is,  however,  neither  within  the  aim  nor  the  scope  of 
this  work  to  follow  the  progress  of  beneficent  reforms  affect- 
ing the  insane,  nor  will  an  attempt  be  made  to  describe  the 
various  lunacy  systems  of  continental  countries  ;  but  brief 
reference  will  be  made  to  certain  features  of  those  of  France, 
Belgium,  and  Prussia. 

In  France  the  insane  poor  and  orphan  and  abandoned 
children  are  made  objects  of  special  care  by  the  state, 
which  readily  accepts  the  obligation  of  supporting  them 
when  relatives  are   unable  to  do  so.     The  long-established 


198  CONTINENTAL    COUNTRIES. 

lunatic  asylum  at  Charenton  is  under  the  immediate  direc- 
tion of  the  National  Government,  and  is  open  to  patients 
from  all  parts  of  the  Republic.  With  this  exception,  the 
public  institutions  for  the  insane  are  local  foundations. 
Each  of  the  eighty-seven  political  divisions  of  France  called 
departments  must  provide  a  public  institution  for  persons  of 
unsound  mind  ;  or  else,  with  the  approval  of  the  Minister 
of  the  Interior,  make  an  agreement  with  a  public  or  private 
asylum  in  the  same  or  an  adjoining  department  to  receive 
its  insane  poor.  The  department,  aided  by  contributions 
from  the  commune  in  which  was  the  home  of  the  patient, 
defrays  the  expense  of  maintaining  its  insane  paupers  when 
the  relatives  are  unable  to  meet  the  charge.  The  proportion 
paid  by  the  commune  depends  upon  the  amount  of  its 
revenue. 

The  sanction  of  the  government  is  necessary  to  the  estab- 
lishment of  a  private  asylum,  and  the  person  applying  to 
the  Prefect  for  a  license  to  open  such  an  institution  must  be 
of  good  moral  character.  He  must  have  received  the  de- 
gree of  doctor  of  medicine,  or  must  show  that  he  has 
secured  the  services  of  a  properly  qualified  physician  to 
supervise  the  medical  department  of  the  proposed  asylum. 
This  physician  must  be  approved  by  the  Prefect,  who  may 
at  any  time,  with  the  concurrence  of  the  Minister  of  the  In- 
terior, discharge  him.  Before  opening  any  asylum  for  the 
insane  it  is  necessary  that  the  rules  respecting  its  interior 
management  be  submitted  to  the  Minister  of  the  Interior. 

Public  and  private  asylums  arc  periodically  inspected  by 
a  committee  consisting  of  the  Prefect  of  the  department, 
the  President  of  the  local  Tribunal,  the  local  Procurcur  of 
the  Republic,  the  Judge  of  the  Peace,  and  the  Mayor  of  the 
Commune.  Public  asylums  are  under  the  supervision  of  a 
committee   of  five   persons   appointed    by  the   Prefects,   of 


ADMISSION  TO  FRENCH  ASYLUMS.  1 99 

whom  one  retires  each  year.  They  hold  meetings  monthly, 
or  oftener  if  necessary.  It  is  the  duty  of  the  Procureur  of 
the  Arrondissement  to  visit  every  public  asylum  in  his  district 
once  in  six  months  and  every  private  asylum  once  in  three 
months,  or  oftener  if  he  thinks  it  necessary.  The  asylums 
are  also  visited  by  the  Prefect  and  other  officials  who  are  re- 
quired to  report  to  the  Minister  of  the  Interior  respecting 
the  condition  and  treatment  of  the  insane. 

Patients  are  consigned  to  asylum  care  in  two  ways.  The 
first  is  compulsory,  and  applies  to  dangerous  lunatics  and 
all  persons,  who,  if  at  liberty,  might  endanger  the  public 
safety.  These  are  dealt  with  as  a  measure  of  police  by  the 
public  authorities — in  Paris,  by  the  Chief  of  Police,  and  in 
the  departments  by  the  Prefects.  In  very  urgent  cases  the 
Commissioners  of  Police  or  the  Mayors  are  authorized  to 
take  provisional  measures  for  restraint,  but  the  matter  must 
at  the  same  time  be  reported  to  the  Prefect.  The  second 
form  of  admission  is  called  "'placement  volontairc.'"  By 
this  method  a  relative  or  friend  applies  to  the  proper  author- 
ities for  the  admission  of  a  lunatic  into  an  asylum.  The 
application  must  be  accompanied  by  a  medical  certificate 
indicating  the  mental  condition  of  the  patient  and  stating 
that  he  is  insane  and  should  be  confined  in  an  asylum.  The 
physician  who  gives  the  certificate  must  not  be  a  relative  of 
the  patient  nor  connected  with  the  asylum  to  whicli  he  is 
committed,  and  the  certificate  must  be  signed  within  fifteen 
days  after  the  physician  has  seen  the  patient. 

Every  person  confined  within  an  insane  asylum  must  be 
dismissed  therefrom  whenever  the  physician  of  the  institu- 
tion asserts  that  a  cure  has  been  effected.  A  husband  or 
wife,  or  more  distant  connection,  or  others  may  demand  the 
removal  of  a  patient  from  an  insane  asylum,  and  the  demand 
must  be  complied  with  unless  the  physician  of  the  establish- 


200  CONTINENTAL    COUNTRIES. 

ment  thinks  that  the  liberty  of  the  patient  would  compro- 
mise public  safety  and  personal  welfare,  in  which  case  he 
makes  known  his  apprehensions  to  the  Mayor,  who  immedi- 
ately forbids  the  dismissal.  The  provisionary  prohibitory 
order  expires  in  two  weeks  unless  the  Prefect,  who  is  in- 
formed of  the  case,  gives  orders  to  the  contrary.  The  Pre- 
fect may  at  any  time  demand  the  immediate  dismissal  of  a 
patient  placed  in  an  insane  asylum  by  the  voluntary  applica- 
tion of  friends. 

A  peculiarity  of  the  French  and  Belgian  lunacy  laws  is 
the  liberal  conception  of  the  right  of  the  patient  to  his  lib- 
erty— a  right  under  the  French  code,  entitled  that  of 
^^Reclamation,''  by  which  a  patient  himself,  or  some  relative 
or  friend,  or  any  person  interested  in  him,  may  claim  his 
discharge  before  a  civil  court.  Of  this  unique  feature  of 
jurisprudence,  the  late  Dr.  Achille  Foville,  Inspector-General 
of  the  Department  for  the  Insane  in  Paris,  says: 

"  Every  one  placed  in  a  lunatic  asylum  may  claim  his  discharge 
before  the  civil  court  as  often  as  he  pleases,  and  at  any  time.  Thanks 
to  this  right,  every  patient  is  at  liberty  to  have  his  mental  con- 
dition examined  by  the  law  of  his  country,  without  delay,  without 
complicated  formalities,  and  without  being  hindered  by  pecuniary 
considerations.  .  .  .  This  right  of  claim  is  evidently  the  strongest 
guarantee  which  the  law  can  give  to  individual  liberty.  It  is 
no  less  valuable,  I  am  convinced,  to  asylum  physicians.  In  my 
opinion,  it  is  a  very  mistaken  view  which  some  of  them  take,  who 
regard  it  as  a  mark  of  personal  distrust,  and  wish  it  to  be  resorted 
to  as  seldom  as  possible.  I,  on  the  contrary,  think  that  this  pro- 
cess furnishes  alienist  physicians  with  the  best  means  of  mini- 
mizing their  responsibility  of  clearing  themselves  from  every 
imputation  of  abuse  of  authority,  and  of  displaying,  in  all  cir- 
cumstances, the  sincerity  of  their  opinions  and  the  rectitude  of 
their  conduct." 

A  marked  peculiarity  of  the  Belgian  system  of  caring  for 
the  insane  is  that  of  boarding  them  in  families  under  govern- 


ADMISSION  TO  BELGIAN  ASYLUMS.  201 

mental  supervision,  as  in  the  colony  of  Gheel.  A  new- 
colony,  Lierneux,  similar  to  Gheel,  has  recently  been  begun 
in  the  Walloon  district,  not  far  from  Liege.  The  number 
of  insane  in  the  asylums  of  Belgium  on  the  1st  of  January, 
1886,  was  8,986.  This  country,  which  is  one  of  the  most 
densely  populated  in  the  world,  contained  at  the  date 
named  nearly  six  millions  of  inhabitants. 

The  support  of  pauper  lunatics  in  Belgium  must  be 
defrayed  by  the  communal  treasury  in  default  of  sufficient 
charitable  endowments.  If  there  is  proof  that  the  revenues 
of  a  commune  are  inadequate  to  this  purpose,  the  province 
is  bound  to  meet  the  requirement.  There  are  three  govern- 
ment asylums  having  accommodation  in  all  for  upwards  of 
1,800  patients.  The  municipal  asylums  of  Bruges  provide 
for  about  1,300  insane.  Besides,  there  are  numerous  smaller 
hospitals  kept  by  individuals  or  religious  communities. 

Licenses  are  required  from  the  government  before  open- 
ing a  public  or  private  asylum.  One  or  more  medical  men 
must  be  connected  with  the  institution,  and  the  patients 
must  be  visited  daily. 

A  medical  certificate  signed  by  a  physician  not  connected 
with  the  asylum  to  which  the  patient  is  committed  is  requi- 
site to  admission.  The  certificate  must  describe  minutely 
all  the  peculiar  symptoms  of  the  patient's  insanity,  must 
state  its  duration,  and  give  particulars  as  to  previous  treat- 
ment. A  sealed  statement  accompanies  the  physician's  cer- 
tificate, declaring  the  cause  of  insanity  and  whether  any 
other  member  of  the  patient's  family  has  been  similarly 
afflicted.  The  medical  certificate  may  be  dispensed  w^ith  in 
urgent  cases,  but  one  must  be  obtained  within  twenty-four 
hours  after  the  patient  is  received  into  the  asylum.  Certifi- 
cates for  the  admission  of  pauper  patients  are  made  by  the 
medical  officer  of  the  poor. 


202  CONTINENTAL   COUNTRIES. 

Notice  of  a  patient's  reception  into  an  asylum  must  be 
forwarded,  not  later  than  one  day  after  reception,  to  the 
Provincial  Governor,  the  Attorney-General  of  the  Arrondisse- 
ment,  the  Cantonal  Judge  of  the  Peace,  the  Burgomaster  of 
the  Commune,  the  Committee  of  Inspection,  and  the  Secre- 
tary of  the  Permanent  Commission.  The  sixth  day  after  a 
patient's  reception  into  an  asylum  the  physician  transmits 
his  observations  from  daily  examinations  of  the  case  to  the 
Attorney-General,  and  eight  days  thereafter  he  must  inform 
the  Secretary  of  the  Permanent  Commission  of  his  patient's 
condition.  Two  medical  men,  members  of  the  Permanent 
Commission,  are  required  to  visit  the  patient  at  intervals  of 
two  months  during  the  first  half  year  that  he  is  an  inmate  of 
an  asylum,  the  first  visit  to  be  made  within  three  days  after 
notice  of  commitment,  and  a  copy  of  the  results  of  their 
examinations  must  be  sent  to  the  Secretary  of  the  Com- 
mission. The  second  half  year  but  one  visit  has  to  be  made 
by  these  officers.  Persons  are  appointed  by  the  Government 
to  visit  all  asylums  as  follows :  Every  three  months  they 
are  inspected  by  the  Attorney-General  of  the  Arrondisse- 
ment ;  every  six  months  by  the  Burgomaster  of  the  Commune ; 
every  year  by  the  Provincial  Governor,  or  by  a  member  of 
the  Provincial  Council  nominated  by  the  Governor.  In  each 
Arrondissement  a  special  committee,  composed  of  several 
members,  are  required  to  visit  annually  all  asylums  coming 
under  their  immediate  jurisdiction  ;  and  three  Government 
Commissioners  are  obliged  to  make  an  annual  report  from 
personal  observation  of  all  asylums  and  every  thing  relating 
to  lunacy  in  Belgium.  Notice  of  discharge,  containing  the 
patient's  name,  a  statement  of  his  mental  condition  at  the 
time  of  discharge,  the  name  of  the  asylum  in  which  he  had 
been  confined,  and  of  the  house  in  which  he  is  going  to 
reside,  must  be  sent  within  twenty-four  hours  after  discharge 


GERMAN  ASYLUMS.  203 

to  the  same  persons  to  whom  notice  of  admission  was 
sent. 

There  are  no  general  laws  regulating  the  care  of  the  insane 
in  Germany,  and  the  manner  of  providing  for  them  varies  in 
the  different  states.  Throughout  the  Empire,  the  institu- 
tions for  this  class  are  small  as  compared  with  those  of 
England,  the  United  States,  and  some  other  countries. 
Many  of  the  buildings  used  for  asylums  before  1850  were 
once  monasteries.  It  is  estimated  that  only  about  one 
third  of  the  insane  in  Germany  are  given  asylum  treatment, 
the  remainder  being  considered  suitable  for  family  care. 
The  number  of  public  institutions  for  the  insane  in  the  Ger- 
man Empire  in  1886  was  103.  Of  private  asylums  there 
were  69.  Besides  these  there  were  29  of  what  are  called 
open  asylums  {Offene  Anstalteri),  which  receive  cases  of 
nervous  disease  and  the  lighter  forms  of  mental  disorder. 
There  were  also  32  private  establishments  for  idiots  or 
the  feeble-minded. 

In  Prussia,  the  insane  are  mostly  committed  to  asylums 
according  as  they  are  curable  or  incurable  ;  but  whatever 
their  mental  state,  it  must  be  set  forth,  together  with  other 
facts,  in  a  physician's  certificate,  which  is  accompanied  by  a 
statement  of  particulars  respecting  the  family  relations  of 
the  patient,  and  bearing  the  signature  of  the  authorities. 
Most  asylums  receive  curable  patients  upon  the  request  of  a 
near  relative  or  other  intimate  acquaintance,  even  though 
such  person  has  no  legal  authority  over  the  patient,  pro- 
vided the  consent  of  the  local  authorities  is  obtained. 
Incurable  patients  are  placed  under  legal  guardianship,  and 
the  petition  for  their  reception  into  an  asylum  is  made  by 
the  guardian  or  other  legal  representative.  In  cases  of 
urgent  necessity,  however,  temporary  commitment  may  be 
made  without  such  petition.     Proprietors  of  private  asylums 


204  CONTINENTAL    COUNTRIES. 

are  required  to  present  to  the  proper  authorities  an  annual 
report  respecting  the  condition  of  their  institutions,  to  keep 
a  daily  register  according  to  a  prescribed  form,  and  to  make 
a  special  statement  regarding  each  patient. 

The  various  provinces  have  different  regulations  respect- 
ing the  reception  of  incurable  paupers  into  their  asylums. 
Some  receive  such  free,  or  the  expense  is  met  by  funds  from 
the  general  revenue  of  the  province ;  others  have  a  fixed 
number  of  free  places,  and  any  demand  in  excess  of  these 
must  be  met  by  the  community  to  which  the  pauper  be- 
longs ;  still  other  provinces  will  receive  incurable  paupers 
only  after  the  expense  of  maintenance  has  been  guaranteed 
by  the  authorities  of  their  places  of  settlement.  Preference 
is  given  in  the  free  places  to  dangerous  cases. 

A  brief  description  of  a  few  representative  institutions  is 
here  presented,  as  illustrating  different  modes  of  caring  for 
the  insane.  Deserving  of  special  attention  are  the  colony 
system  of  Clermont  en  Oise  in  France,  the  colony  of  Gheel 
in  Belgium,  and  the  Alt-Scherbitz  asylum  in  the  Province  of 
Saxony,  Prussia.  The  two  last  are  separately  dealt  with  in 
subsequent  chapters. 

GAUSTAD   INSANE   ASYLUM — NORWAY. 

In  the  care  of  the  insane  there  is  little  to  be  gleaned  from 
Norway,  if  we  accept  as  a  criterion  the  Gaustad  asylum 
near  Christiania,  the  capital  of  this  northern  region.  An 
examination  of  this  institution  produces  in  the  mind  of  the 
stranger  unpleasant  sensations,  and  for  aught  there  is  of 
ocular  demonstration  to  the  contrary,  it  might  have  been 
built  for  the  retention  of  some  of  those  stormy  characters  of 
Scandinavian  mythology,  whose  wild  doings  are  familiar  to 
us  through  ancient  song  and  saga.  The  massive  construc- 
tion of  the  refractory  wards  seems  sufficient  to  resist  the 


GAUSTAD  ASYLUM NORWAY.  20$ 

hammer  of  Thor  himself.  Indeed,  it  is  questionable  whether 
the  ponderous  weapon  of  the  god  of  thunder  could  have 
made  any  sensible  impression  on  any  part  of  these  towers  of 
strength. 

The  Gaustad  asylum,  pleasantly  situated  among  the  green 
hills,  is  reached  after  a  short  drive  northwesterly  from 
Christiania.  This  is  one  of  the  three  public  asylums  of 
Norway.  It  was  established  about  the  middle  of  the 
present  century,  since  which  time  those  at  Rotvold  and  Eg 
have  been  erected.  The  brick  buildings  with  slate  roofs  are 
mainly  of  two  stories.  There  is  an  administration  building, 
back  of  which  to  the  right  and  left  are  two  opposite  ranges 
of  blocks  connected  by  corridors.  The  women  occupy  one 
side  of  the  asylum  and  the  men  the  other.  On  the  day  of 
my  visit  the  inmates  numbered  i68  men  and  152  women. 

The  several  departments  were  warmed  by  stoves.  Except- 
ing the  provision  made  for  first-class  patients,  the  sleeping 
arrangements  were  mostly  on  the  plan  of  associated  dormito- 
ries. The  floors  and  walls  were  generally  bare  and  the 
rooms  presented  a  cheerless  aspect.  There  appeared,  more- 
over, to  be  a  lack  of  supervision,  and  the  treatment  seemed 
severe.  In  one  of  the  halls  nearly  half  of  the  men  were  lying 
on  the  floor.  In  one  of  the  sitting-rooms  not  less  than  twenty 
were  in  that  position.  There  was  also  a  dreary  and 
neglected  appearance  about  the  small  yards  or  airing-courts, 
which  are  inclosed  by  high  stone  walls. 

All  of  the  outside  windows  had  iron  gratings,  except  in 
the  refractory  rooms,  where  the  windows  were  high  above 
the  floor  and  out  of  the  reach  of  the  patients.  The  arrange- 
ments for  ventilation  were  faulty.  For  discipline,  an  immense 
douche  was  provided,  the  water  falling  ten  or  twelve  feet 
through  a  one-and-a-half-inch  pipe.  In  the  refractory  ward 
the  massive  bedsteads  were  of  two-inch  solid  oak,  as  were 


206  CONTINENTAL   COUNTRIES. 

also  the  tables  and  benches,  which  were  firmly  secured  to 
the  floor  by  iron  fastenings.  The  doors  were  solid  and 
strongly  barred.  There  were  a  number  of  canvas-padded 
rooms. 

Many  of  the  women  wore  strong  dresses  fastened  at  the 
back.  The  garments  generally  were  of  substantial  material. 
In  several  of  the  yards  a  considerable  number  of  women 
were  lying  on  the  ground.  In  the  women's  workroom  some 
were  engaged  in  spinning,  sewing,  or  knitting.  For  the  use 
of  the  better  class  of  quiet  patients  there  are  ornamental 
grounds  inclosed  by  a  picket  fence  about  eight  feet  high. 

The  state  asylums  of  Norway  are  controlled  by  the  Min- 
ister of  Justice,  and  the  local  asylums  by  the  communal 
authorities.  Many  of  the  insane  are  boarded  out  by  poor- 
law  committees,  whose  proceedings  are  supervised  by  a 
commission.  All  persons  of  unsound  mind  have  a  legal 
claim  upon  the  state  for  relief.  Most  of  the  lunacy  legisla- 
tion in  Norway,  as  well  as  in  Sweden  and  Denmark,  has 
been  with  reference  to  committal  and  discharge,  and  more 
attention  has  been  given  to  the  protection  of  society  than  to 
the  rights  of  the  insane. 

CONRADSBERG   INSANE   ASYLUM — SWEDEN. 

Some  of  the  hard  and  forbidding  aspects  of  the  Gaustad 
asylum  in  Norway  are  noticeable,  though  in  a  less  marked 
degree,  in  Sweden.  The  Conradsbcrg  asylum,  on  the  out- 
skirts of  Stockholm,  although  a  modern  institution,  presents 
little  that  is  instructive,  whether  we  view  its  external  sur- 
roundings or  its  internal  furnishing.  Both  acute  and  chronic 
cases  are  here  cared  for.  The  buildings  are  of  two  stories, 
with  basement,  and  have  lateral  wings  projecting  from  the 
central  or  administrative  department. 

This    asylum    contained,    on  the    day   of    my  visit,    252 


CONRADSBERG  ASYLUM— SWEDEN.  20/ 

patients — 140  men  and  112  women.  All  who  are  able  are 
required  to  pay,  and  districts  sending  patients  are  responsi- 
ble for  their  maintenance.  First-class  patients  are  received 
at  two  kro7ier^  and  second  class  at  seventy-five  ore  *  per  day. 
The  latter  live  in  associated  wards,  as  do  also  the  third  class, 
who  are  paid  for  by  the  authorities.  The  dress  of  the  second 
and  third  class  was  uniform.  There  were  about  twenty  first- 
class  patients,  thirty-five  of  the  second  class,  and  the  re- 
mainder were  third-class  patients. 

The  rooms  of  the  first  class  had  no  carpets,  and  were 
plainly  furnished ;  but  here,  as  in  the  second-class  department, 
were  settees,  also  a  few  pictures  on  the  walls.  The  bare  floors 
and  scant  furnishing  do  not  impress  one  favorably,  though  it 
must  be  acknowledged  that  a  condition  of  scrupulous  clean- 
liness was  everywhere  observed.  The  dormitories  of  the 
second  and  third  class  contained  from  three  to  eight  beds, 
with  narrow  wooden  bedsteads  of  the  French  box  pattern. 

There  are  two  refractory  wards,  one  for  each  sex.  These 
contained  about  thirty  inmates,  with  one  attendant  to  every 
eight  patients.  The  single  rooms  of  the  refractory  ward, 
like  the  larger  apartments,  have  windows  so  high  as  to  be 
above  the  reach  of  patients.  The  bedsteads  were  of  the  box 
pattern  with  sides  two  inches  in  thickness,  and  they  were 
firmly  secured  to  the  floor.  The  doors  in  this  ward  were  very 
solid,  being  three  inches  thick.  Apertures  were  provided 
for  observation  of  the  occupants  of  the  single  rooms  in  this 
department.  Heating  was  effected  by  means  of  hot-water 
pipes. 

A  large,  well-lighted,  and  pleasant  apartment  was  used  as 
the  women's  workroom.  Here  were  two  tables,  around 
which  patients  were  busily  sewing.  In  the  way  of  industries, 
besides  sewing  and  spinning,  something  is  done  at  weaving 

'  A  krone  (100  ore)  is  equivalent  to  about  twenty-six  cents. 


208  CONTINENTAL    COUNTRIES. 

linen.  The  men  do  a  little  at  carpentering,  shoemaking, 
painting,  and  general  repairs. 

There  were  no  padded  cells.  No  mechanical  restraint  came 
under  my  observation.  The  airing-courts  were  small  and  in- 
closed by  high  fences. 

A  contracted  recreation  yard  that  I  entered  had  nothing 
cheerful  about  it,  and  resembled  those  of  the  insane  de- 
partments of  some  of  our  country  poorhouses.  There  was 
but  little  grass  in  the  yard,  owing  to  the  constant  tread  of 
feet.  In  a  pavilion  furnished  with  benches  many  patients 
were  seen  lying  down.  In  the  women's  department  were 
some  shade  trees,  and  the  patients  were  here  provided  with 
wooden  benches  and  settees  having  backs.  In  a  small,  plain- 
looking  chapel,  furnished  with  benches  without  backs,  Sun- 
day services  were  held. 

The  patients,  classified  as  to  mental  condition,  dined  in 
association,  except  in  the  case  of  the  refractory,  to  whom 
the  food  was  conveyed.  Wooden  spoons  were  used  for  the  lat- 
ter class.  The  ordinary  dining-rooms  are  on  the  second 
floor.  The  tables  were  of  two-inch  hard  wood.  In  some 
cases  knives  and  forks  were  furnished,  in  others  only  spoons 
were  allowed.  The  knives,  where  used,  were  of  the  ordinary 
table-knife  pattern.  The  dinner  for  the  second  and  third 
class  patients  consisted  of  soup  made  of  barley  and  vegeta- 
bles, fresh  beef  and  potatoes,  rye  bread  and  butter.  Their 
breakfast  was  rye  bread  and  butter  with  milk.  It  was  stated 
that  the  supper  would  be  oatmeal  porridge  and  milk.  Small 
beer  was  allowed  to  be  used  freely  during  the  day. 

This  asylum,  like  all  others  in  Sweden,  public  and  private, 
is  controlled  by  the  government  medical  authorities. 

ST.    HANS    HOSPITAL — DENMARK. 

A  short  ride  westerly  by  rail  from  Copenhagen  brings  one 
to  this  well-known  institution,  which  is  reputed  to  hold  the 


ST.  HANS  HOSPITAL — DENMARK.  209 

most  advanced  position  of  the  Danish  asylums.  Like  that 
of  Aarhus  and  Vordingborg,  it  receives  both  acute  and 
chronic  patients  from  allotted  districts,  while  the  asylum  at 
Viborg  is  specially  designed  for  chronic  insane  of  the  whole 
kingdom.  Nothing  further  is  necessary  to  admit  a  patient 
into  any  of  these  establishments  than  the  certificate  of  a  duly 
qualified  physician.  There  are  no  special  lunacy  laws  gov- 
erning asylums,  nor  is  there  any  systematic  or  regular  govern- 
mental inspection  or  supervision  of  the  insane.  The  St. 
Hans  Hospital  is  supervised  by  a  committee  of  magistrates, 
and  is  under  the  immediate  charge  of  a  resident  physician 
and  superintendent,  who  is  assisted  by  a  strong  staff  of  medi- 
cal officers.  At  the  time  of  my  visit  there  were  in  this  insti- 
tution 400  men  and  340  women  divided  into  first,  second,  and 
third  classes. 

The  buildings  are  detached,  and  comprise  a  number  of 
separate  departments.  That  devoted  to  administration  pur- 
poses forms  one ;  the  hospital  for  the  treatment  of  acute 
cases,  another ;  a  third  is  used  for  chronic  male  patients; 
and  a  fourth  is  occupied  by  chronic  female  patients  ;  while 
the  kitchens  and  wash-house  are  also  separate  structures. 
The  surrounding  grounds,  embellished  with  flowers  and 
shrubbery,  include  a  park  and  lake.  There  are  also  an 
abundance  of  shade  trees  and  an  extensive  system  of 
gravelled  walks.  The  grounds  belonging  to  the  hospital 
department  are  especially  remarkable  for  their  elaborate 
ornamentation  and  careful  keeping.  A  portion  of  the  estate, 
which  contains  about  ninety  acres,  borders  on  the  RcEskilde 
Fjord. 

The  asylum  buildings  are  chiefly  of  three  stories,  with 
day  and  work  rooms  below,  and  sleeping-rooms  above.  It 
was  observed  that  the  sash  most  generally  used  was  of  iron 
and  had  small  square  panes.  The  institution  has  about 
eighty  single  rooms  ;  the  remainder  are  associated  dormi- 


2IO  CONTINENTAL    COUNTRIES. 

tories,  with,  in  some  cases,  sixteen  beds  in  a  room.  The 
first-class  patients  occupy  single  rooms  ;  the  second  small, 
and  the  third  larger  associated  dormitories.  The  single 
rooms  are  of  good  size  and  well  lighted.  For  the  seclusion 
of  unquiet  patients  there  are  about  fifty  rooms,  the  windows 
of  which  are  protected  by  wooden  shutters.  The  bedsteads 
were  of  wood  and  of  the  French  or  box  pattern.  The  bed- 
ding was  plentiful,  and  included  a  mattress  laid  on  straw. 
The  male  and  female  patients  have  their  meals  apart  in 
large  dining-halls,  and  so  rigid  is  the  separation  that  two 
kitchens  are  provided — one  for  men  and  the  other  for 
women.  Food  is  conveyed  from  them  to  the  dining-rooms 
in  wagons  constructed  for  the  purpose.  There  is  chapel 
accommodation,  and  there  are  also  pleasant  amusement 
rooms,  including  a  billiard-room,  and  a  bowling  alley.  The 
sitting  or  day  rooms  were  in  general  supplied  with  books  and 
other  reading  matter. 

Various  plans  are  devised  to  keep  all  occupied  who  are 
able  to  work.  Among  the  women  were  some  who  objected 
to  every  employment  except  knitting,  and  their  labor  in  this 
direction  more  than  met  the  requirements  of  the  institution. 
It  was  therefore  directed  that  stockings  should  be  knit  not 
only  for  the  inmates,  but  also  for  sale.  During  the  year 
preceding  my  visit  eleven  hundred  pairs  were  made  in  excess 
of  the  wants  of  the  institution.  To  further  engage  the  in- 
mates in  this  direction  knit  undershirts  were  substituted  for 
a  woven  fabric  previously  purchased  for  them. 

Among  the  men  who  are  able  and  willing  to  work  are 
many  mechanics  who  are  employed  at  their  various  trades. 
All  the  necessary  painting,  blacksmithing,  and  carpentering 
is  done  by  them,  as  also  the  tailoring.  Their  labor  is  also 
made  use  of  in  constructing  sewers  and  water-works,  in 
draining   the    land,    clearing    up    underbrush,    and    making 


ST.  HANS  HOSPITAL — DENMARK.  211 

gravelled  walks  ;  also  in  converting  the  woods  belonging  to 
the  hospital  into  pleasure  grounds,  and  carefully  tilling  and 
caring  for  the  grounds  generally.  The  bucket-system  is  in 
use  here,  and  the  asylum  waste  is  utilized  to  benefit  the 
land.  Outdoor  work,  when  the  season  and  weather  permit, 
is  substituted  for  the  regular  indoor  employment  of  manu- 
facturing wooden  shoes  and  paper  boxes ;  and  by  this 
thorough  systemization  of  labor  the  cost  of  maintenance  is 
reduced,  while  the  grounds  and  buildings  are  beautified  and 
improved. 

Beach  bathing,  which  the  patients  greatly  enjoy,  is  an 
advantage  possessed  by  this  institution.  Even  those  who 
most  oppose  any  prescribed  treatment  yield  more  readily  to 
the  strand  bathing  in  summer  than  to  the  warm  house  baths 
in  winter ;  and  the  promenade  to  and  from  the  beach  is 
looked  forward  to  as  one  of  the  pleasures  which  the  summer 
months  will  bring.  On  account  of  limited  accommodations  at 
the  beach  it  is  impossible  to  bathe  all  the  patients  every 
day ;  therefore  the  baths  are  divided  into  sanitary  and 
ablutionary.  The  chronic  cases  are  bathed  but  once  or  twice 
a  week,  while  those  who  seem  really  benefited  receive  baths 
daily.  The  superintendent,  Dr.  Steenberg,  says :  "  There 
have  been  abundant  occasions  when  I  could  date  the  be- 
ginning of  convalescence,  or  at  least  essential  improvement 
both  in  body  and  mind,  from  the  day  when  the  patient 
began  strand  bathing."  The  water  of  the  Fjord  on  which 
St.  Hans  Hospital  is  immediately  situated  is  clear,  but  the 
sea  bottom  near  the  shore  is  muddy  and  rough  with  sharp 
stones  ;  therefore  it  is  necessary  to  float  the  bath-house 
some  distance  from  the  shore.  For  this  reason  it  is  deemed 
unsafe  to  allow  patients  who  are  likely  to  commit  suicide  the 
use  of  the  shore  bath  without  special  precautions  being 
taken.     The  superintendent  says  :  "  Although  during  all  the 


212  CONTINENTAL    COUNTRIES. 

years  I  have  been  here  but  one  person  has  met  his  death  by 
drowning,  I  cannot  deny  that  many  a  time  I  am  not  a  little 
anxious  for  patients  with  acute  melancholia  to  whom  I  permit 
the  use  of  the  shore  bath  on  account  of  its  unquestionable 
beneficial  effect  upon  the  disease."  As  affording  facilities 
for  bathing  a  larger  number  of  patients,  including  some  of 
pronounced  suicidal  tendencies,  a  bath-yard  in  the  Fjord  was 
under  consideration. 

The  institution  appeared  to  be  well  organized,  and  the 
treatment  seemed  kind.  A  large  number  of  attendants  were 
employed,  and  it  was  said  that  restraint  was  very  rarely  re- 
sorted to.  A  highly  favorable  opinion  was  derived  from  the 
brief  visit  made  to  this  asylum. 

FRIEDRICHSBERG    ASYLUM    FOR    THE    INSANE,    NEAR    HAM- 
BURG,   GERMANY. 

This  large  and  modern  institution  is  under  the  control 
and  direction  of  the  authorities  of  Hamburg.  At  the 
entrance  to  the  grounds  is  a  snug  porter's  lodge,  and  near 
by  is  the  residence  of  the  chief  physician.  A  little  to  the 
right  is  the  "  Pensionnat,"  a  large  building  occupied  by  board- 
ers of  the  first  and  second  classes.  Farther  on  to  the  left  is 
the  principal  edifice,  which  is  symmetrically  and  plainly  built 
of  red  brick,  the  central  structure  being  three  stories  and 
the  lateral  portions  two  stories  in  height.  The  administra- 
tive department  occupies  a  middle  position  between  the 
male  and  female  sections  of  this  building.  In  front  is  a 
large  park  used  for  recreation  and  promenades.  Rearward 
are  cultivated  grounds  affording  outdoor  industrial  employ- 
ment for  the  insane. 

At  the  time  of  my  visit  the  institution  contained  i,oiO 
inmates.  These  included  acute  and  chronic  cases.  There 
are  four  classes  or  grades  of  patients,  received  at  rates  vary- 


FRIEDRICHSBERG  ASYLUM HAMBURG.  21 3 

ing  according  to  accommodation.  Apart  from  these  grades 
there  is  a  further  classification  into  sections,  as  follows:  i. 
Incurables;  2.  Those  curable  and  able  to  work;  3.  New  ar- 
rivals ;  4.  Refractory  and  such  as  require  close  supervision. 
The  plan  of  treating  curable  with  incurable  insane  patients 
was  disapproved  of  by  the  officials. 

For  the  four  classes  paying  different  rates  the  arrangements 
vary.  The  first  class  have,  according  to  stipulation,  one  apart- 
ment with  mahogany  furniture  and  one  attendant  to  each 
patient.  The  number  and  variety  of  meals  being  rather  singu- 
lar, the  dietary  is  given  for  a  single  day.  The  food  is  slightly 
changed  on  three  days  of  the  week.  The  first  breakfast  for 
this  class  consists  of  an  allowance  of  prepared  coffee,  cream 
and  sugar,  biscuit  or  rusk.  Their  second  breakfast  comprises 
an  allowance  of  soup  or  tea,  butter  and  extras,  including 
meat,  white  bread,  cheese,  etc.  At  noon  they  partake  of 
soup,  meat  or  fish,  fowl,  game,  potatoes  and  other  vegetables. 
In  the  afternoon  they  sit  down  to  a  meal  resembling  the 
first  breakfast.  In  the  evening  they  have  soup  or  tea,  white 
bread,  butter,  and  extras.  During  the  day  they  are  allowed 
half  a  bottle  of  beer  with  black  bread.  Wine  is  given  only 
by  medical  direction. 

The  second  class  are  allowed  one  attendant  and  a  room 
with  varnished  furniture  to  every  two  patients.  Their  daily 
meals  include  two  breakfasts,  as  enumerated  for  the  first  class, 
with  the  exception  of  meat  and  cheese.  At  noon  and  in  the 
afternoon  they  again  partake  of  food  similar  to  that  for  the 
first  class.  In  the  evening  they  have  soup  or  tea  with  bread 
and  butter.  They  also  receive  daily  allowances  of  beer  and 
bread.  For  these  classes  there  is,  on  the  men's  side,  a  room 
with  verandah  opening  into  an  adjoining  garden.  Here  are 
also  provided  smoking-room,  piano-room,  billiard-room,  and 
bath-room.     On  the  female  side  there  is  a  sitting-room  with 


214  CONTINENTAL    COUNTRIES. 

a  verandah  opening  into  a  garden.  The  other  accommoda- 
tions here  include  a  ladies'  saloon  with  piano,  a  small  library^ 
and  also  facilities  for  bathing.  There  is,  besides,  a  dining-room 
capable  of  accommodating  thirty  persons,  for  the  common 
use  of  ladies  and  gentlemen. 

The  third  class  have  separate  accommodation  in  the  prin- 
cipal building,  and  sleep  in  associated  dormitories  containing 
from  three  to  six  beds  each.  There  is  one  attendant  to 
every  ten  or  twelve  patients.  Their  first  breakfast  consists  of 
an  allowance  of  coffee  with  cream  and  sugar,  and  white  bread ; 
their  second  breakfast,  of  warm  beer  or  tea,  with  bread 
and  butter.  At  noon  they  have  soup,  with  rice  or  groats ; 
four  times  a  week,  boiled,  and  three  times  roasted  meat 
varied  with  fish.  Potatoes  are  provided  every  day,  and  three 
times  a  week  other  vegetables.  In  the  afternoon  they  re- 
ceive coffee  with  cream  and  sugar,  and  the  usual  allowance 
of  bread  and  butter.  In  the  evening,  tea  or  soup  is  served 
with  black  bread. 

The  fourth  class  occupy  dormitories  containing  from  three 
to  seventeen  beds  each.  Their  dining-rooms  are  on  the  as- 
sociate plan.  There  is  one  attendant  to  every  fifteen  pa- 
tients. Their  first  breakfast  consists  of  coffee  with  milk  and 
brown  sugar,  and  an  allowance  of  white  bread.  The  second 
breakfast  for  the  men  includes  beer,  bread  and  butter;  for 
the  women,  warm  beer,  bread  and  butter.  At  noon  this 
class  partake  of  soup  similar  to  that  for  the  third  class.  Six 
times  a  week  they  have  meat  ;  once  a  week,  herrings  ;  four 
times  a  week,  vegetables  with  pulse  or  coddled  grains ;  and 
potatoes  every  day.  In  the  afternoon  they  have  coffee  as  at 
the  first  breakfast,  with  bread  and  butter.  In  the  evening 
they  sit  down  to  tea  or  soup,  with  black  bread. 

This  institution  is  specially  designed  for  the  care  of  pa- 
tients   having  their    residence   in    Hamburg  and   suburban 


FRIEDRICHSBERG  ASYLUM HAMBURG.  21  5 

districts.  So  far  as  accommodation  permits,  however,  pa- 
tients of  the  first  three  classes  are  received  from  other 
localities.  The  ordinary  charge  covers  board,  lodging, 
care,  medical  attendance,  supervision,  etc.  An  advance  of 
four  weeks'  maintenance  is  required  from  the  first  three 
classes,  besides  a  deposit  for  extras,  such  as  excursions, 
cigars,  tobacco,  repairs,  and  washing.  The  patients  are 
obliged  to  bring  with  them  clothing  and  linen  plainly- 
marked.  A  duplicate  list  of  these  articles  is  made  out,  one 
of  which  is  returned  at  the  time  of  committal  by  way  of 
receipt.  When  suitable  and  necessary  clothing  is  not  fur- 
nished, the  officers  of  the  institution  are  authorized  to  ob- 
tain the  same  and  charge  it  to  those  responsible  for  main- 
tenance. If  valuables  are  intrusted  to  patients  by  wish  of 
friends  and  sanction  of  the  physician,  the  institution  gives 
no  guarantee  of  their  safety.  Letters  to  and  from  inmates 
pass  through  the  hands  of  the  chief  physician. 

The  day-rooms  in  the  principal  building  are  heated  by 
Dutch  tile-stoves.  The  corridors  are  warmed  by  hot-water 
pipes.  The  lighting  is  by  gas.  From  each  of  the  da\'-rooms 
is  a  passage  leading  to  a  small  garden  or  court.  For  pur- 
poses of  amusement  there  are  provided  a  bowling-green, 
billiard-room,  and  a  large  music-hall  with  pianos.  In  all  the 
departments  of  the  female  side  there  were  pianos.  On 
Sundays,  the  patients,  with  consent  of  the  chief  physician, 
attend  divine  service  in  the  chapel  of  the  asylum,  which  is 
provided  with  separate  entrances  and  accommodation  for 
the  male  and  female  patients. 

The  total  number  of  attendants  was  given  as  loi,  or  51 
men  and  50  women.  The  men  enter  at  a  salary  of  eighteen 
marks  *  per  month,  rising  at  the  rate  of  three  marks  every 
two  months  until  the  sum  of  thirt}'  marks  is  reached.     The 

'  A  mark  (100  pfennings)  is  equivalent  to  about  twenty-four  cents. 


2l6  CONTINENTAL    COUNTRIES. 

women  attendants  enter  at  fifteen  marks,  rising  to  twenty- 
four  marks  per  month.  There  are  in  addition  nine  principal 
gardes,  each  of  whom  receives  forty-two  marks  per  month, 
and  twenty-six  {^.x^^Xq  gardes  at  thirty-six  marks  per  month. 

In  the  first,  second,  and  third  departments  ordinary 
window  sashes  hung  on  hinges  are  in  use.  The  panes 
measure  lo  x  14  inches.  The  soHtary  rooms  are  variously 
planned.  The  blankets  used  in  them  were  of  strong  material 
and  double  hemmed.  The  windows  of  some  of  these  rooms  are 
high  in  the  wall ;  some  are  protected  by  wire  screen-work  ; 
others  again  are  grated  with  heavy  iron  bars.  The  latter 
were  noticeable  in  one  of  the  sub-departments  for  the  most 
violent.  In  the  refractory  wards  the  patients  seemed  greatly 
disturbed.  Here  the  glass  was  of  unusual  thickness.  There 
are  asphalt  floors  in  the  rooms  occupied  by  the  very  filthy. 

A  considerable  number  of  the  chronic  insane  are  provided 
for  in  eight  two-story  houses  or  pavilions,  plainly  and  cheaply 
constructed  of  brick.  In  connection  with  each  is  a  small 
yard.  Each  of  these  buildings  contains  sixty  beds.  Four 
gardes  sleep  in  each  house  on  the  same  floor  with  the  pa- 
tients. The  window  panes  are  of  a  goodly  size.  Food  is 
brought  here  from  a  general  kitchen,  where  it  is  cooked  by 
steam.  The  buildings  are  in  the  midst  of  beautiful  grounds  ; 
but  the  spectacle  of  patients  restricted  to  small  yards 
produces  an  unfavorable  impression  on  the  mind  of  the 
visitor.  As  one  walks  about  the  grounds  and  sees  the 
patients  through  iron  screen-work  or  wooden  palings,  the 
idea  of  a  park  menagerie  is  disagreeably  suggested.  It 
was  asserted  by  the  management  that  there  was  no  "  forc- 
ing," and  that  no  mechanical  restraint  whatever  was  re- 
sorted to. 

About  one  hundred  inmates  were  at  work  on  the  farm  and 
in  the   garden.     The  farm  was   stocked   with  cows,  horses. 


FRIEDRICHSBERG  ASYLUM HAMBURG.  21 J 

swine,  poultry,  etc.,  in  the  care  of  which  the  patients  assist. 
The  barns  and  sheds  are  conveniently  planned  and  spacious, 
and  have  large  gardens  and  grounds  about  them.  There  are 
also  sheds  in  which  the  insane  perform  certain  kinds  of  work 
in  unfavorable  weather.  Two  patients  were  seen  at  work  in 
the  tailor's  shop,  in  which,  it  was  said,  there  were  sometimes 
as  many  as  six  employed.  Three  were  busy  in  the  cabinet 
shop.  The  other  workers  comprised  four  upholsterers, 
three  carpenters,  one  tinsmith,  five  painters,  and  two  black- 
smiths. 

It  has  already  been  indicated  that  there  is  a  classification 
of  the  patients  into  social  grades.  But  the  principle  of  clas- 
sification is  of  much  wider  application  than  would  be  gath- 
ered from  the  mere  mention  of  four  classes.  It  extends  to 
the  mental  and  physical  condition  of  the  patients.  The  aim 
is  not  only  to  observe  with  care  the  social  distinctions  and 
requirements,  but  also  to  provide  each  of  the  several  classes 
and  their  numerous  divisions  with  separate  accommodations 
and  conveniences — down  even  to  a  separate  tea-kitchen. 
But  so  complex  is  this  method  of  classification,  that  it  is  ad- 
mittedly a  source  of  much  embarrassment  to  the  administra- 
tion, and,  in  consequence,  it  is  carried  out  with  difficulty. 
The  higher  grades  do  not  care  to  be  brought  in  contact  with 
those  whom  they  consider  beneath  them,  while  the  humbler 
classes  become  envious  of  the  better  treatment  of  those 
ranking  higher  in  the  social  scale,  and  the  poorer  patients, 
seeing  others  apparently  favored,  make  demands  that  cannot 
be  gratified. 

The  construction  of  the  buildings  is,  as  far  as  possible, 
adapted  to  this  principle  of  classification.  On  both  the 
men's  side  and  the  women's  side  are  divisions  for  the  differ- 
ent classes — each  in  a  sort  of  separate  dwelling  with  distinct 
living  and  sleeping  accommodations.     The  gardens  are  gen- 


2l8  CONTINENTAL    COUNTRIES. 

erally  well  kept,  and  the  separate  tea-kitchens  referred  to,  in 
almost  every  instance,  open  out  upon  small  parterres.  In  all 
the  principal  parts  of  the  institution  there  was  an  abundance 
of  blossoming  plants,  and  the  pleasing  combination  of  out- 
door and  indoor  attractions  appeared  to  have  a  beneficial 
influence  on  the  inmates. 

PROVINCIAL   INSANE   ASYLUM — HALLE,  PRUSSIA. 

This  asylum,  which  is  the  older  of  the  two  institutions 
for  the  insane  of  the  Province  of  Saxony,  has  accommoda- 
tion for  600  patients.  On  the  day  of  my  visit  the  inmates 
numbered  585,  of  whom  304  were  men.  Like  that  of  Alt- 
Scherbitz,  the  asylum  receives  both  acute  and  chronic  cases. 
Its  government  is  also  similar.  It  is  located  in  the  country 
near  Halle,  and  being  an  old  institution,  the  buildings,  apart 
from  the  new  hospital,  suggest  little  that  would  be  of  advan- 
tage to  those  in  sympathy  with  modern  progress. 

The  land  attached  to  the  asylum  does  not  exceed  sixty- 
nine  English  acres,  but  it  is  brought  under  high  cultiva- 
tion by  the  inmates.  On  the  day  of  my  visit  in  of  the 
men  were  engaged  in  fanning,  gardening,  and  other  out- 
door work;  18  were  working  as  tailors,  carpenters,  masons, 
and  blacksmiths  ;  and  the  same  number  were  doing  house- 
work. Of  the  women,  40  were  engaged  in  sewing  ;  80  at 
washing,  peeling  potatoes,  and  other  domestic  work  ;  and  12 
were  employed  in  the  garden.  Extensive  changes  and 
repairs  had  been  undertaken.  Work  was  progressing  for 
the  introduction  of  a  new  system  to  utilize  the  sewage.  It 
was  intended  to  distribute  it  by  means  of  narrow  trenches 
over  a  tract  of  about  four  acres  set  apart  for  garden  pur- 
poses. All  gas-pipes  and  water-pipes  were  to  be  inclosed 
within  a  large  conduit,  so  as  to  render  them  more  accessible 
for  repairs.     The  red  bricks  used  for  building  were  of  un- 


PROVINCIAL  ASYLUM HALLE.  219 

usual  size,  being  10  inches  long,  4-|  inches  wide,  and  2f  inches 
thick.  They  cost  thirty-two  marks,  or  nearly  eight  dollars 
per  thousand.  In  a  cottage  connected  with  the  farm  resided 
twenty  quiet  patients,  who  worked  in  the  fields  under  con- 
ditions of  greater  freedom  than  the  others. 

An  interesting  department  of  the  asylum  is  an  infirmary 
for  female  patients.  This  detached,  one-story  building  is 
capable  of  accommodating  twenty  persons,  allowing  1,420 
cubic  feet  of  air-space  to  each  inmate.  The  bedsteads  had 
woven-wire  bottoms,  and  were  provided  with  comfortable 
mattresses.  The  ventilation,  heating,  and  all  sanitary  ar- 
rangements were  quite  complete.  The  windows  and  doors 
were  without  fastenings.  The  warden's  room  has  a  large 
window  overlooking  the  whole  of  the  interior,  so  that  con- 
stant watchfulness  may  be  maintained.  The  temperature 
of  the  body  of  each  patient  in  the  infirmary  is  taken  twice 
a  day  and  recorded. 

In  the  dormitories  of  the  asylum  proper,  the  beds  were 
provided  with  adjustable  head  and  foot  boards.  First-class 
patients  have  single  rooms  ;  most  of  the  other  inmates  oc- 
cupy associated  dormitories. 

In  the  dining-room,  at  the  close  of  the  meal  one  of  the 
patients  rose  and  reverently  returned  thanks. 

BURGHOLZLI   CANTONAL    ASYLUM — SWITZERLAND. 

This  asylum,  opened  in  1870,  is  situated  amidst  beautiful 
Alpine  scenery  at  Burgholzli,  about  three  miles  from  Zurich. 
It  is  under  the  immediate  direction  of  a  resident  Medical 
Superintendent,  who  is  aided  by  three  assistant  physicians. 
The  front  or  central  building  is  flanked  on  either  side  by 
wings  of  three  stories,  all  of  stone.  There  is  a  detached 
building  accommodating  a  limited  number  of  the  chronic 
insane. 


220  CONTINENTAL    COUNTRIES. 

The  asylum  is  designed  to  accommodate  260  patients,  but 
at  the  time  of  my  visit  it  was  overcrowded.  Patients  are 
admitted  to  the  asylum  upon  the  certificate  of  a  reputable 
physician,  the  consent  of  a  near  relative  or  guardian  having 
been  obtained.  There  must  also  be  a  guarantee  for  pay- 
ment of  the  charge  for  support.  Recent  cases  are  admit- 
ted in  preference  to  chronic,  the  institution  being  intended 
for  a  hospital  for  the  treatment  of  acute  insanity  ;  while  the 
asylum  at  Rheinau  is  especially  provided  for  chronic  cases. 
The  two  establishments  constitute  the  public  provision 
made  by  the  canton  of  Zurich  for  its  insane.  The  inmates 
are  divided  into  three  classes  according  to  payment. 
Patients  sent  by  the  authorities  are  charged  sixty-three 
centimes  per  day.  Connected  with  the  asylum  are  seventy 
acres  of  land.  Every  department  has  its  airing-court  with 
high  walls.  The  yards  for  first-class  patients  are  in  front  and 
are  laid  out  in  walks  and  embellished  with  flowers.  The 
windows  of  the  buildings  have  outside  ornamental  gratings 
and  sashes  opening  on  hinges. 

In  the  third-class  dining-halls  were  solid  oak  tables, 
benches  without  backs,  and  dishes  of  glazed  iron.  Table- 
cloths were  in  use.  First-class  patients  usually  take  their 
meals  in  their  own  rooms. 

The  dormitories  were  furnished  with  large-sized  wooden 
French  bedsteads,  having  slats  with  coiled  steel  springs  at 
either  end.  For  epileptics  were  provided  special  bedsteads 
having  cushioned  sideboards  to  prevent  the  patients  from 
falling  out  or  otherwise  injuring  themselves.  For  those 
showing  a  disposition  to  tear  their  clothing  the  beds  are 
covered  with  oil  sail-cloth.  First-class  patients  have  single 
rooms ;  second-class,  quite  small  associated  dormitories  ;  while 
the  third-class  occupy  apartments  containing  from  six  to  ten 
beds. 


BURGHOLZLI  ASYLUM—SWITZERLAND.  221 

Chapel  accommodation  is  provided,  and  religious  services 
are  held  every  Sunday.     There  is  also  an  amusement  hall. 

For  violent  patients  who  need  special  treatment,  dresses 
of  sail-cloth  secured  at  the  back  are  used,  also  muffs  in 
exceptional  cases.  In  each  refractory  ward  there  were  ten 
isolating  cells.  These  were  of  a  goodly  size,  but  the  ventila- 
tion was  imperfect.  The  windows  were  about  eight  feet 
above  the  floor,  and  the  doors  were  very  heavy  and  solid. 
There  appeared  to  be  a  lack  of  care  of  the  refractory  class. 
In  a  cell  in  the  female  department,  for  a  patient  whose 
habits  were  said  to  be  very  destructive,  there  was  nothing 
but  a  loose  heap  of  straw  for  a  bed.  Many  of  the  patients 
seemed  violent  and  excited.  It  was  stated  that  during  the 
twenty-four  hours  preceding  my  visit,  one  male  patient  had 
been  isolated  for  three  hours,  and  one  female  for  five  hours. 
For  the  same  period  thirty  women  were  recorded  as  having 
been  violent  in  the  daytime  and  eighteen  during  the  night, 
W'hile  there  were  six  men  violent  by  day  and  seven  by  night. 
Fifteen  men  and  eight  women  were  allowed  the  privilege  of 
walking  in  the  park. 

A  peculiarity  in  the  treatment  here  is  the  mode  of  giving 
hot-water  baths  to  refractory  patients.  The  bath-tubs  have 
wooden  lids,  in  which  are  circular  apertures  for  the  neck. 
The  body  and  limbs  are  concealed  in  the  tub,  from  which 
only  the  head  protrudes,  the  lid  being  secured  by  iron  locks. 
The  water  is  heated  to  the  temperature  of  95°  F.  Under 
what  is  termed  the  prolonged  or  permanent  bath,  patients 
are  kept  in  water  from  two  to  ten  hours  continuously,  this 
treatment  being  intended  to  act  as  a  sedative.  In  such 
cases  the  patients  are  fed  in  the  bath.  The  writer  saw  two 
men  and  one  woman  undergoing  this  treatment.  One  of 
the  former  indicated  great  exhaustion  by  a  feeble  move- 
ment of  his  head  ;  the  other  two  were  violent  and  vocifer- 


222  CONTINENTAL    COUNTRIES. 

ous.  The  scene  left  a  painful  impression.  The  day's  re- 
port showed  one  man  to  have  been  immersed  in  this  way 
for  three  hours,  another  seven  hours,  another  ten  hours,  and 
one  woman  eight  hours. 

The  closets  are  arranged  for  the  use  of  buckets,  the 
contents  of  which  are  utilized  on  the  farm. 

There  are  two  attendants  to  every  fifteen  inmates.  A 
male  attendant  acts  as  night-watch  in  the  men's  department, 
a  female  attendant  performs  a  like  duty  in  the  women's 
section,  and  there  is  a  general  night-watch  for  the  whole 
building.     The  house  is  heated  by  steam. 

The  industrial  system  is  indicated  by  the  following  state- 
ment :  Seventy-eight  women  were  employed  at  general  do- 
mestic work  ;  sixteen  were  found  knitting  and  sewing  in  a 
workroom.  Twenty-two  men  were  at  work  on  the  farm, 
three  at  trades,  and  fifteen  at  domestic  work.  The  laundry 
washing  is  done  mostly  by  hand,  thus  giving  employment 
to  some  of  the  excitable  patients. 

The  increase  of  insanity  in  Switzerland  was  in  a  large 
measure  attributed  to  ''hereditary  tendency,  intemperance, 
inter-marriage,  bad  nourishment  and  consequent  anaemia." 

LA   SALPETRIERE — PARIS. 

This  is  one  of  the  vast  alms-house  receptacles  for  the  pau- 
pers of  Paris,  and  it  is  set  apart  exclusively  for  females. 
The  buildings,  with  surrounding  gardens,  courts,  and  prom- 
enades, occupy  a  space  of  seventy-four  acres.  The  whole  is 
inclosed  by  a  high  brick  wall.  The  enormous  size  of  the 
institution  may  be  conceived  from  the  fact  that  the  build- 
ings altogether  comprise  forty-five  large  blocks,  and  are 
lighted  by  more  than  five  thousand  five  hundred  windows. 
Here  are  the  aged  infirm,  as  well  as  defective  children,  in- 
sane persons,  epileptics,  and  idiots.     For  the  children  there 


LA    SA LP ETRlkRE— PARIS.  223 

is  a  special  section,  and  in  connection  therewith  a  school. 
At  the  time  of  my  visit  the  total  population  amounted  to 
6,311,  of  whom  590  were  of  unsound  mind.  Two  sections 
are  occupied  by  the  insane  ;  and  these,  together  with  a  sec- 
tion for  idiots,  constitute  one  of  the  departments  of  this 
institution.  There  is  one  attendant  to  eight  or  ten  of  the 
insane. 

In  a  large  yard  with  gravelled  walks  and  shady  trees, 
there  are  twelve  small  brick  buildings,  with  broad  project- 
ing roofs  like  those  of  Swiss  chalets.  Each  interior  is  a 
single  apartment  fourteen  feet  square.  These  cottages,  fur- 
nished with  sliding  doors,  were  used  for  a  peculiar  class  of  the 
disturbed  insane.  The  clean-washed  floors  were  of  oak.  The 
beds  had  wire  springs  and  abundant  bedding.  In  each  cot- 
tage were  two  moderate-sized  strongly  grated  windows  with 
hinged  sashes.  Heating  was  effected  from  below,  two 
furnaces  being  sufficient  to  warm  the  cottages. 

For  filthy  cases,  the  large  associated  dormitories  had  iron 
bedsteads  of  the  box  pattern,  with  drawers  underneath. 
Thick  straw  mattresses  were  in  use,  and  in  some  cases  oil- 
cloth formed  part  of  the  bed  furnishing. 

There  were  numerous  cells  in  the  insane  department. 
These  had  two  openings,  one  into  an  airing-court  and 
another  into  a  corridor.  Twelve  feeble  imbecile  women, 
lightly  secured  in  arm-chairs,  were  seen  in  one  of  the  day- 
rooms.  In  the  bathing  department  there  was  a  douche,  and 
the  tubs  were  arranged  in  separate  stalls. 

Provision  is  made  for  entertainments,  which  include  music 
and  dancing.  During  my  visit,  a  large  number  of  patients 
were  seen  in  one  of  the  apartments  listening  to  music  from 
a  piano-forte. 

In  one  immense  kitchen  the  cooking  is  done  for  the  whole 
establishment.     The  insane  eat  in  a  special  dining-room.     It 


224  CONTINENTAL    COUNTRIES. 

was  said  that  wine  is  allowed  at  each  meal,  also  grapes  in 
their  season.  Both  of  these  were  seen  on  the  tables.  An 
attractive  new  dining-hall  was  in  course  of  erection. 

This  being  a  very  old  institution,  it  has  little  to  engage 
the  attention  of  the  inquirer  after  modern  methods,  though 
it  is  interesting  as  showing  the  kind  of  provision  that  a 
great  metropolis  has  made  for  the  care  of  some  of  its  depend- 
ent classes.  Besides,  one  is  curious  to  see  a  place  noted  for 
its  associations  with  the  great  reformer  Pinel.  This  is  a  com- 
panion institution  to  the  historically  famous  Bicetre.  The 
latter  is  for  male  patients,  and  is  similarly  managed. 

THE   ASYLUM    OF   STE.   ANNE — PARIS. 

By  many  French  specialists  in  the  treatment  of  mental 
disease,  this  is  considered  a  model  institution.  It  is  situated 
near  the  southern  boundary  of  Paris,  is  of  modern  construc- 
tion, and,  like  many  other  public  edifices  of  the  city,  is 
of  cut  stone.  It  is  built  in  sections  with  connecting  corri- 
dors and  intervening  courts,  and  is  plain  in  its  exterior. 
At  the  time  of  my  visit,  the  patients  numbered  upwards  of 
900,  and  the  sexes  were  about  equally  divided. 

All  classes  of  the  insane  are  received  at  Ste.  Anne,  though 
the  institution  is  in  no  sense  an  asylum,  but  a  reception 
house  and  hospital  for  the  treatment  of  acute  insanity.  If, 
from  a  careful  diagnosis,  the  patient,  upon  admission,  is 
found  to  be  suffering  from  acute  insanity,  he  is  retained  for 
treatment  ;  if  his  disease  has  become  chronic,  he  is  trans- 
ferred to  some  other  asylum,  such  as  Vaucluse,  Ville  Vraz, 
or  Burge.  The  hospital  is  supported  entirely  by  the  De- 
partment of  the  Seine,  and  no  paying  patients  are  received, 
the  aim  being  to  relieve  those  who  are  unable  to  pay  for 
skilful  treatment.  One  is  impressed  with  the  feeling  that 
the  medical  idea  here  predominates.     The  staff  is  large,  and 


STE.  ANNE — PARIS.  22 5 

there  is  thorough  clinical  instruction  by  physicians  from  the 
Paris  Faculty  of  Medicine.  The  Sisters  of  St.  Joseph,  of 
whom  there  were  forty-two,  assisted  by  day  servants,  had 
charge  of  the  female  side.  Each  received  for  her  services 
twenty-five  francs  per  month.  In  the  wards  for  quiet 
patients  there  were  three  attendants  to  fifty  patients  ;  in  the 
ward  for  filthy  cases,  four  attendants  to  fifty  patients  ;  and 
in  the  refractory  ward,  four  attendants  to  every  twelve 
patients. 

The  sleeping  accommodation  is  on  the  second  floor.  On 
the  lower  floor  are  dining,  sitting,  and  other  rooms  for  day 
use.  The  rooms  of  the  refractory  wards  open  upon  irregular 
courts,  the  walls  of  which  are  partially  sunk  so  as  to  afford 
glimpses  of  the  country.  The  isolating  cells  are  made  very 
secure  ;  some  have  window-blinds.  The  bedsteads  in  these 
cells  were  of  iron  strongly  secured  to  the  floor,  and  were 
made  with  a  central  depression  and  outlet.  Some  restrain- 
ing chairs  for  the  violent  were  observed  placed  against  the 
wall.  There  was  one  padded  room  for  men  and  another 
for  women.  The  airing-courts,  which  contained  many  noisy 
patients,  were  cheerless  and  quite  limited  in  size.  In  con- 
nection with  the  infirmary  is  a  small  court,  in  which  were 
flowers  and  shrubbery.  Roofed  galleries  are  provided,  per- 
mitting exercise  without  exposure.  The  various  wards  are 
heated  by  means  of  pipes  laid  under  perforated  iron  plates 
in  the  floor. 

In  the  bath-room  the  tubs  were  not  only  separated  from 
each  other,  but  set  away  from  the  walls.  There  were  here  a 
plunge  bath,  a  hose  for  use  upon  the  patients,  and  a  douche 
with  arrangement  for  securing  the  person  while  undergoing 
treatment.  In  one  of  the  rooms  of  the  bathing  department 
were  stationary  glazed  iron  foot-baths.  There  were,  besides, 
arrangements   for  vapor  baths.     A  room  was  specially  set 


226  CONTINENTAL    COUNTRIES. 

apart  for  washing  and  shampooing  after  the  use  of  the  vapor 
bath.  As  in  some  other  French  institutions,  hydropathy  has 
a  prominent  place  in  the  treatment,  and  there  is  much  re- 
Hance  placed  upon  it  as  a  means  of  allaying  excitement. 

The  wards  of  this  institution  are  small,  which  is  desirable 
in  the  treatment  of  acute  cases.  Many  of  the  apartments, 
however,  are  poorly  lighted  from  small  airing-courts,  and  all 
are  quite  plainly  furnished.  There  appeared  to  be  a  lack  of 
air,  light,  and  room,  and  the  provision  generally  did  not  seem 
well  adapted  to  secure  the  best  results  in  curative  treatment. 

INSANE   ASYLUM   AT   CHARENTON. 

This,  one  of  the  very  old  institutions  of  France,  founded  in 
1642,  is  in  the  suburbs  of  Paris,  near  the  park  of  Vincennes, 
and  receives,  as  do  French  institutions  generally,  curable 
and  incurable  patients.  Charenton  has  had  a  troublous 
history,  having  been  several  times  destroyed  and  succes- 
sively restored.  It  is  said  that  at  one  time  it  was  a  mon- 
astery belonging  to  the  monks  of  St.  Jean  de  Dieu,  who 
here  undertook  the  care  of  the  insane.  Following  the  revo- 
lution of  1830  it  became,  under  Louis  Phillippe,  the  property 
of  the  State,  and  was  at  that  time  rebuilt  of  white  limestone 
pretty  much  as  it  now  stands.  The  place  has  interesting 
associations  from  its  connection  with  the  names  of  Esquirol 
and  other  distinguished  alienists  who  here  practised  their 
profession  and  wrote  many  of  their  valuable  works. 

The  buildings  occupy  a  commanding  site  on  a  finely  ter- 
raced slope.  From  the  chapel,  which  is  above  the  other 
structures,  is  obtained  a  view  of  a  charming  landscape 
stretching  along  the  course  of  the  Seine.  This  edifice  ac- 
commodates about  one  hundred  persons.  The  terraced 
airing-courts,  of  which  there  are  eight  in  the  male  and  an 
equal  number  in  the  female  department,  measure  each  from 


CHARENTON.  22/ 

one  hundred  to  two  hundred  feet  square,  and  have  covered 
places  for  shelter  on  either  side.  From  these  courts,  made 
cool  by  shade  and  beautified  by  fountains  and  flowers, 
there  are  delightful  views,  which  must  have  a  salutary  effect 
on  the  inmates.  Besides  these  courts,  there  are  spacious 
grounds  shaded  by  large  trees.  In  these  open  spaces,  at 
certain  hours  of  the  day  in  favorable  weather,  all  save  the 
refractory  take  recreation. 

On  the  day  of  my  visit,  the  asylum  contained  285  men 
and  300  women.  Most  of  the  patients  are  from  the  middle 
class  of  society  and  are  supported  principally  by  relatives 
or  friends.  There  are  two  resident  physicians,  two  medical 
assistants,  a  consulting  surgeon,  and  an  apothecary.  A  resi- 
dent chaplain  of  the  Roman  Catholic  Church  daily  conducts 
religious  services  for  such  patients  as  desire  to  attend.  Sub- 
ordinate to  the  physician,  the  female  department  is  under 
the  charge  of  the  Sisters  religieuse  of  the  order  of  St.  Augus- 
tine, who  act  as  attendants  and  are  assisted  by  servants.  The 
female  servants  wear  blue  dresses  with  white  caps  and  aprons. 
Each  of  the  Sisters  receives  twenty-five  francs  per  month. 

That  portion  of  the  institution  occupied  by  the  patients 
is  but  two  stories  high.  The  windows  of  the  upper  floor 
have  gratings  with  five-inch  square  spaces ;  those  of  the 
ground-floor  are  without  guards.  The  asylum  is  planned  so 
as  to  admit  plenty  of  light.  The  buildings  are  warmed  by 
hot-water  pipes. 

Each  of  the  dining-rooms  has  ten  tables,  each  table  ac- 
commodating six  persons.  Cushioned  benches  without  backs 
were  used  instead  of  chairs.  The  table  furnishing  included 
crockery,  wine-glasses,  water-bottles,  spoons,  forks,  etc.  In 
the  refractory  ward,  no  knives  were  used,  and  its  dining-room 
benches  were  uncushioned.  Wine  is  supplied  at  all  the  meals. 
The  diet  is  regulated  by  the  price  paid. 


228  CONTINENTAL   COUNTRIES. 

The  dormitories  are  on  the  second  floor.  Iron  bedsteads 
measuring  about  four  feet  in  width  were  in  use.  The  mat- 
tresses, made  of  horse-hair  and  wool,  were  laid  on  coil  springs, 
and  the  bedding  was  good  and  plentiful.  Patients  requiring 
special  provision  had  deep  box-bedsteads  filled  with  marine 
grass.  These  had  outlets  in  the  centre.  The  uncleanly 
occupied  a  separate  one-story  building,  and  had  also  a  sepa- 
rate airing-court.  In  the  dormitories  for  women,  over  the 
beds  of  the  quieter  patients  were  pretty  dimity  canopies. 

In  the  bath-rooms,  the  tubs  are  arranged  so  as  to  be  ac- 
cessible from  all  sides.  As  at  Ste.  Anne's,  bathing  is  an  im- 
portant factor  in  treatment.  The  baths  include  medicated, 
Turkish,  and  Roman.     There  are  also  douches  and  packs. 

A  comfortably  furnished  room,  in  which  were  two  long 
tables,  was  provided  with  cushioned  benches  and  chairs  at 
each  side.  This  apartment  is  used  by  the  male  patients  as 
a  reading-room.  The  library  is  valuable,  and  includes  the 
books  and  writings  of  Esquirol,  which  he  presented  to  the 
asylum.  Besides  the  collection  of  medical  works,  there  is 
an  abundance  of  entertaining  reading  in  the  form  of  books, 
papers,  and  magazines.  There  are  no  less  than  three  billiard- 
rooms.  In  the  corridors  adjoining  these  places  of  recrea- 
tion, a  light  was  kept  burning  for  the  accommodation  of 
smokers.  There  is  also  a  spacious  amusement-room  in 
which  the  patients  assemble  every  Sunday  from  7  P.M.  to 
10  P.M. 

The  refractory  wards  communicate  with  a  wide  corridor 
having  windows  about  eight  feet  above  the  floor.  For  the 
extremely  filthy  of  both  sexes,  there  are  small  courts  for 
seclusion,  and  into  these  open  a  few  isolating  cells.  Each 
of  the  latter  has  a  cemented  floor,  and  is  warmed  by  steam. 
Box-bedsteads  arc  here  used,  though  in  one  of  the  cells  on 
the  men's  side,  in  which  the  atmosphere  was  very  offensive, 
nothing  but  straw  was  seen   for  a  bed,  and  the  floor  and 


CLERMONT  EN  01 SE.  229 

walls  were  besmeared  with  filth,  presenting  an  unsightly 
appearance.  Strait-jackets,  it  was  stated,  were  used  on 
an  average  four  or  five  times  a  day.  The  restraining  chairs, 
three  of  which  were  occupied  at  the  time  of  my  visit,  have 
cushioned  straps  for  the  feet.  There  were  no  cribs  of  any 
kind.  Even  the  movable  ones,  formerly  used  for  carrying 
patients  about,  had  been  discarded.  It  was  asserted  here, 
as  elsewhere,  that  none  were  likely  to  be  found  in  France. 

No  industrial  system  exists,  although  inmates  who  desire 
to  work  in  the  garden  or  among  the  flowers  are  permitted  to 
do  so,  and  light  needlework  is  provided  for  women. 

At  the  time  of  my  visit  patients  were  received  into  the 
institution  at  from  1,000  to  1,400  and  even  1,800  francs  per 
annum.  The  number  of  attendants  average  one  to  about 
every  nine  patients.  Such  of  the  men  as  paid  900  francs 
extra,  and  those  of  the  women  who  paid  850  francs  extra, 
were  allowed  a  servant  as  well  as  a  private  room,  and  ante- 
room for  servant.  By  the  payment  of  a  still  higher  sum, 
a  patient  was  entitled  to  a  suite  of  apartments  in  addition 
to  a  servant's  room.  The  furniture,  etc.,  where  no  extra  fees 
were  paid,  was  nearly  uniform.  There  are  about  forty  single 
rooms  for  each  sex.  These  are  fitted  up  somewhat  elabo- 
rately, with  mahogany  bedsteads  and  other  corresponding 
furniture.  Many  of  the  apartments  have  parquet  floors  and 
are  highly  polished  with  wax. 

What  seemed  remarkable  in  an  institution  possessed  of 
so  many  comforts  and  having  accommodation  for  so  many 
private  patients,  was  the  fact  that  it  had  few  pictures  on  its 
walls,  though  a  tasteful  display  of  bric-a-brac  was  noticed  in 
some  of  the  rooms  for  women. 

CLERMONT   EN   OISE — FRANCE. 

The  asylum  at  Clermont,  organized  as  a  private  and  in- 
dustrial institution,  has  long  attracted  attention  by  reason  of 


230  CONTINENTAL    COUNTRIES. 

its  successful  plan  of  colonizing  the  insane.  It  is  situated  in 
the  department  of  the  Oise,  thirty-six  miles  north  of  Paris. 
Up  to  the  time  of  my  visit  it  had  been  managed  and  superin- 
tended by  that  distinguished  alienist,  Dr.  Gustave  Labitte, 
who  was  then  assisted  by  his  son,  Dr.  George  Labitte. 

There  were  about  1,580  patients  under  the  care  of  the 
general  management.  These  were  distributed  over  the  three 
departments  of  the  asylum  as  follows  :  One  thousand,  includ- 
ing twenty  epileptic,  idiotic,  and  insane  children,  at  the 
Clermont  central  asylum  ;  about  440  in  what  is  known  as  the 
colony  of  Fitz-James;  and  140  in  a  second  colony  at  Villers. 
The  central  of^ce  at  Clermont  is  the  headquarters  of  the 
superintendent,  and  is  in  telephonic  communication  with 
Fitz-James  and  Villers.  Besides  receiving  insane  poor  from 
several  outlying  departments  or  districts,  this  institution 
admits  boarders  on  terms  arranged  by  special  contract.  Of 
the  total  number  of  patients,  it  was  estimated  that  about 
319  were  boarders  and  the  remainder  paupers. 

For  the  maintenance  of  the  pauper  insane  the  authorities 
paid,  at  the  time  of  my  visit,  at  the  rate  of  one  franc,  twenty 
centimes  per  day.  The  indigent  insane  supported  by  their 
friends  were  received  at  the  same  rate.  Boarders  having  pri- 
vate rooms  and  better  fare  paid  250  francs  per  month,  or,  if 
they  had  their  own  servant,  350  francs  per  month.  Single  bed- 
rooms were  allowed  to  those  who  paid  the  higher  prices,  and 
associated  dormitories  with  from  five  to  sixteen  beds  were 
provided  for  those  who  paid  the  lower  rates.  The  boarders, 
many  of  whom  live  at  Fitz-James,  do  no  work. 

Taking  the  three  departments  in  order,  we  begin  with  the 
central  asylum  at  Clermont,  connected  with  which  are  some 
fifty  acres  of  improved  and  garden  ground.  Both  sexes  are 
here  cared  for,  a  strict  separation  being  maintained.  Among 
the  inmates  of  the  male  department  were  about  fifty  epilep- 


CLERMONT  EN   01 SE.  23 1 

tics,  between  eighty  and  ninety  sick  and  filthy,  and  150  quiet 
patients,  from  the  last  of  whom  laborers  for  the  grounds  are 
selected.  Each  class  occupies  a  separate  section  provided 
with  associate  apartments  for  sleeping  and  eating.  The 
arrangements  for  female  inmates  are  substantially  the  same 
as  those  for  men.  For  the  quiet  class  in  the  male  depart- 
ment there  are  three  attendants  to  one  hundred  and  fifty 
patients  ;  for  the  refractory,  four  to  forty  ;  and  for  the  twenty 
children,  two  attendants.  The  sleeping  apartments  are  so 
arranged  that  the  attendants  can  render  prompt  assistance 
in  case  of  emergency.  Patients  paid  for  by  the  authorities 
have  different  sleeping  accommodation  from  that  of  indi- 
gent patients  supported  by  their  friends.  The  former  sleep 
in  associated  dormitories  containing  forty-five  beds  each  ;  the 
latter  occupy  smaller  apartments,  each  having  sixteen  beds. 

In  the  wards  for  filthy  patients,  the  bedsteads  were  of  the 
deep  box  pattern.  The  sheets  were  laid  directly  on  sea  grass, 
which  was  changed  daily.  In  this  way,  it  was  said,  the  beds 
were  more  easily  and  cheaply  kept  clean.  The  metallic  bottom 
had  a  depression  in  the  centre  with  outlet.  A  breadth  of 
carpet  was  laid  on  the  tile  floor  beside  each  bed.  The  ques- 
tionable practice  of  keeping  uncleanly  and  violent  patients 
much  of  the  time  in  bed  prevailed  here. 

The  infirmary  on  the  second  floor,  in  which  are  kept  all 
suspected  of  suicidal  tendencies,  as  well  as  the  violent  re- 
quiring special  restraint,  has  grated  windows.  The  iron  bars 
are  five  and  a  half  inches  apart.  Ordinarily,  the  windows  have 
four  lockable  sashes,  the  two  smaller  ones  being  at  the  top ; 
and  all  are  hung  on  hinges.  In  this  portion  of  the  building 
the  bedsteads  were  of  iron.  For  restraining  excited  patients 
a  peculiar  method,  and  one  not  confined  to  Clermont,  is 
practised.  The  patient  is  attired  in  a  strong  dress  with  long 
sleeves  and  legs,  the  extremities  of  which  are  secured  by 


232  CONTINENTAL    COUNTRIES. 

cloth  bands  to  the  side  and  foot  boards  of  the  bedstead.  A 
band  similar  to  these  is  attached  to  the  collar  of  the  dress 
and  fastened  to  the  head-board,  thus  holding  the  patient  in 
a  recumbent  position. 

There  are  ten  cells  for  isolation  in  the  whole  establishment^ 
all  of  which,  at  the  time  of  my  visit,  were  unoccupied.  They 
are  much  like  the  other  rooms,  except  that  they  are  made 
secure  by  wooden  blinds.  The  floors  are  of  oak  and  waxed. 
The  bedsteads  here,  as  in  the  infirmary,  were  of  iron,  box  pat- 
tern, with  holes  at  the  head,  foot,  and  sides  for  fastening  re- 
straining bands  when  they  are  considered  necessary.  There 
were  no  padded  cells.  There  were  two  restraining  chairs, 
which  were  said  to  be  seldom  used.  Narcotics  were  sometimes 
given  to  allay  excitement.  The  strait-jacket  or  camisole  was 
used  in  cases  of  extreme  violence. 

The  dormitory  of  a  refractory  ward  that  I  inspected  had 
grated  windows.  The  pine  floors  were  neatly  waxed  ;  the 
bedsteads  were  of  iron.  Two  attendants  slept  in  an  apartment 
adjoining  and  overlooking  the  ward. 

On  one  side  of  a  room  on  the  first  floor,  the  windows  are 
placed  high  in  the  wall.  On  the  opposite  side,  opening  to  the 
adjoining  court,  the  windows  are  lower  and  double  the  size 
of  the  others.  The  furniture  was  of  the  plainest  description  ; 
the  tables  and  benches  were  deal.  Adjoining  is  a  small  dor- 
mitory for  such  as  are  unable  to  go  up-stairs.  The  objection- 
able arrangement  of  high  windows  already  described  was 
seen  in  a  building  in  course  of  erection. 

The  airing-courts  are  surrounded  by  high  walls  and  are 
thus  entirely  separated  one  from  the  other.  They  are  shaded 
by  trees,  and  generally  measure  from  200  to  300  feet  square. 
The  airing-court  for  boarders  on  the  female  side  is  very 
large,  well  laid  out,  and  ornamented  with  flowers  and  shrub- 
bery.    It  is  divided  by  railings  into  three  portions,  occupied 


THE   COLONY  OF  FITZ-JAMES.  233 

by  the  quiet,  the  unquiet  or  refractory,  and  the  uncleanly. 
In  the  centre  of  that  part  of  the  court  which  is  nearest  to 
the  main  building,  is  a  detached  open  pavilion  used  by  the 
women  patients  for  sewing  and  reading.  In  the  division 
for  the  filthy  class,  some  of  the  patients  were  standing  or 
walking  about,  some  sitting,  some  squatting,  and  some  even 
lying  on  the  pavement.  There  w^as  here  a  general  appear- 
ance of  untidiness  and  disorder,  doubtless  attributable  to  a 
lack  of  attendants. 

Some  new  two-story  buildings  were  in  course  of  erection  ; 
the  upper  portions  being  intended  for  dormitory  purposes 
and  the  ground-floor  solely  for  day  use. 

The  institution  dress  for  men  in  summer  includes  a  blue 
blouse  worn  over  a  jacket  of  the  same  color,  dark  woollen 
pantaloons,  and  shoes  with  wooden  soles.  In  winter  a  warm 
jacket  or  coat  is  added.  To  all  except'  boarders  clothing  is 
furnished  by  the  management. 

At  the  central  asylum  of  Clermont,  it  was  said  that  the 
inmates  were  employed  as  far  as  practicable.  The  women 
sew  for  the  institution.  The  men  are  chiefly  occupied  in 
vegetable  gardening.  Two  were  employed  as  coopers,  four 
as  cabinet-makers  and  joiners,  four  as  painters,  two  as 
tinsmiths,  seven  as  bakers,  twelve  as  shoemakers,  six  as 
mattress-makers,  and  a  few  were  engaged  in  making  general 
repairs.  Reading  and  assembly  rooms  are  connected  with 
the  institution. 

The  colony  of  Fitz-James,  which  is  about  a  mile  distant 
from.  Clermont,  presents  to  the  stranger  many  points  of  in- 
terest. Industry,  order,  and  freedom  are  noticeable  through- 
out the  whole  establishment.  There  are  no  enclosing  walls. 
The  two-story  buildings  of  the  administrative  section,  sur- 
rounded by  gardens,  parks,  and  meadows,  are  plain,  and  are 
planned  so  as  to  afford  sleeping  apartments  above  and  day- 


234  CONTINENTAL   COUNTRIES. 

rooms  below.  Prominent  among  these  buildings  is  one  al- 
lotted to  boarders,  in  which  are  a  billiard-room  and  a  library. 
Here  was  also  an  organ.  All  the  apartments  in  this  building, 
including  the  dining  and  day  rooms,  were  comfortably  and 
tastefully,  though  not  luxuriously  furnished.  The  day  and 
sitting  rooms  had  plush-covered  ottomans,  cushioned  chairs, 
and  other  upholstered  furniture.  The  number  of  attendants 
was  large.  The  apartments  are  arranged  so  as  to  admit  of 
servants  sleeping  in  rooms  communicating  on  either  side 
with  the  boarders  on  whom  they  wait. 

The  insane  poor  sleep  in  associated  dormitories,  contain- 
ing from  twenty  to  thirty  beds  each.  There  are  no  interior 
partitions,  and  the  windows,  which  are  opposite  each  other, 
are  kept  open  not  only  in  summer,  but  also  in  winter.  The 
bedsteads  were  of  iron.  The  bedding  consisted  of  one 
straw  and  one  woollen  mattress,  linen  sheets,  and  woollen 
blankets.  In  every  case  the  beds  were  neatly  made  up. 
The  clean  waxed  floors  added  to  the  tidy  appearance  of 
the  apartments. 

A  short  walk  from  the  main  buildings  brings  one  to  an 
establishment  called  the  "  Little  Chateau."  Here,  under 
conditions  of  much  freedom,  a  number  of  "  lady  boarders" 
are  provided  for,  in  accordance  with  the  requirements  of 
their  individual  preferences  and  temperaments. 

In  another  direction  from  the  administrative  section,  and 
forming  a  somewhat  remarkable  colony  by  itself,  is  the  large 
laundry  {la  section  de  Bc'crel),  where  the  patients  engaged 
at  laundrying  reside.  The  laundry  buildings  are  arranged 
on  two  sides  of  a  court,  and  the  women  are  effectually 
secluded.  This  interior  space  is  large,  and  made  pleasant 
with  fllowers  and  greensward.  The  rooms  are  well  lighted. 
They  were  comfortably  though  plainly  furnished,  and  tidily 
kept.     There  was  a  variety  of  wholesome  food.     The  dining- 


THE   COLONY  OF  FITZ-JAMES.  235 

room  tables  were  of  deal.  Earthen  dishes,  glasses,  and  tin 
spoons  were  used.  The  laundry  machinery  is  propelled  by 
steam.  Here  all  the  washing  of  the  establishment  is  done. 
A  novel  arrangement  in  laundrying  is  found  in  this  depart- 
ment. In  a  very  large  room  with  stone  floor  is  a  long  and 
broad  cement  vat,  through  which  flows  a  stream  of  pure  soft 
water  that  has  been  turned  from  its  course  for  service  here. 
Those  engaged  in  washing  are  ranged  on  either  side  of  this 
immense  vat,  which  is  at  a  convenient  elevation  from  the 
floor.  The  different  articles  are  first  laid  on  the  marginal 
slope  of  the  trough,  rubbed  with  soap,  and  then  washed  and 
rinsed  in  the  flowing  stream.  The  clothes,  when  practicable, 
are  dried  in  the  open  air.  The  most  violent  of  the  female 
patients  who  cannot  be  kept  at  work  that  does  not  require 
muscular  exertion  are  engaged  in  washing  by  hand  ;  others 
less  excitable  are  employed  at  the  machines,  or  in  spreading 
the  linen  to  dry;  while  the  more  delicate  are  occupied  with 
folding  and  smoothing  the  linen.  The  grounds  here  are 
sufficiently  extensive  to  afford  recreation  and  considerable 
freedom  ;  at  the  same  time  there  is  the  seclusion  necessary 
for  the  protection  of  the  insane  women. 

The  colonies  of  Fitz-James  and  Villers  have  upwards  of  a 
thousand  acres  of  farming  land.  The  majority  of  the  male 
pauper  patients  are  employed  at  general  farm-work.  They 
are  divided  into  groups  of  ten  or  fifteen,  and  are  directed 
and  assisted  by  an  attendant.  Among  so  large  a  number 
there  may  be  found  those  adapted  to  every  requirement  of 
farm  industry.  By  carefully  studying  the  tastes,  disposition, 
and  ability  of  each  patient,  selection  is  made  of  those  to 
whom  can  be  assigned  a  specific  charge,  such  as  the  care  of 
certain  tools.  In  this  way  the  land  is  thoroughly  cultivated, 
the  farm  implements  kept  in  repair,  and  the  domestic  ani- 
mals properly  cared  for.     Vegetables  in  great  variety  are 


236  CONTINENTAL    COUNTRIES. 

produced  in  quantities  sufficient  to  meet  the  wants  of  the 
institution.  Dr.  Labitte  says  :  "  We  have  been  able  for 
many  years  to  raise  upon  the  institution  grounds,  with  the 
exception  of  an  occasional  purchase,  all  our  cattle  and 
horses."  In  the  capacious  farm  buildings  and  stock-yards, 
which  take  up  five  acres,  were  thirty  horses  and  a  large  herd 
of  cows  and  growing  stock.  In  the  piggery  were  upwards 
of  a  hundred  swine.  Not  a  little  attention  is  given  here  to 
the  breeding  of  rabbits.  Great  pains  is  taken  to  secure  the 
best  breeds  of  farm  stock,  and  the  care  bestowed  upon  it  is 
often  rewarded  by  prizes  taken  at  exhibitions  and  fairs.  Dr. 
Labitte  says  :  "  The  insane  patient  who  lives  in  the  midst 
of  this  progress  is  proud  of  the  prizes  that  the  farm  receives 
each  year,  and  of  which  he  can  attribute  to  himself  a  share. 
He  shows  complacently  to  visitors  the  animals  he  has  raised 
and  for  which  he  cares."  In  connection  with  the  farm  build- 
ings at  Fitz-James  there  is  accommodation  for  a  small  colony 
of  farm  laborers,  for  whom  have  been  fitted  up  day-rooms 
on  the  ground-floor,  and  associated  dormitories  above.  As 
one  enters  the  court  around  which  are  arranged  the  stables, 
sheep-folds,  cow-sheds,  and  piggeries,  he  is  struck  with  the 
neatness  and  order  with  which  they  are  kept.  Among  the 
attendants  are  several  practical  farmers  who  w^ork  with  and 
direct  the  insane.  About  the  barns  was  seen  a  large  group 
of  patients  cheerfully  preparing  for  work  after  their  mid-day 
meal.  One  in  a  gleeful  mood  was  setting  out  for  the  field 
mounted  on  one  of  the  work-horses. 

The  sewage,  after  being  conveyed  to  vats  in  the  fields, 
passes  successively  through  four  of  them,  which  are  placed  at 
different  elevations  for  the  purpose  of  separating  the  liquid 
from  the  solid.  This  Dr.  Labitte  regarded  as  the  best-known 
system  of  sewage  utilization  in  connection  with  asylums. 

But  agriculture  is  not  the  only  industry  of   Fitz-James. 


THE   COLONY  OF  FITZ-JAMES.  237 

While  many  of  the  patients  are  occupied  on  the  land,  there 
are  a  considerable  number  chosen,  on  account  of  previous 
experience,  to  work  at  various  trades.  On  the  farm  are  two 
mills  for  grinding  wheat,  a  forge  and  a  machine-shop  for  re- 
pairing agricultural  implements,  a  mill  used  in  making 
cement,  a  cider  manufactory,  a  bakery,  an  abattoir,  and  a 
dairy.  Each  of  the  flouring,  mills  has  three  run  of  stone. 
One  is  propelled  by  an  engine  of  thirty  horse-power,  and  the 
other  by  water.  These  mills,  especially  the  one  having  the 
steam-engine,  were  shown  with  much  pride.  In  the  black- 
smith's shop  were  long  rows  of  horseshoes,  all  made  by  the 
patients. 

In  order  to  make  the  classification  still  more  perfect, 
simplify  attendance,  and  give  the  greatest  amount  of  free- 
dom to  each  class,  there  are  selected  for  the  colony  of  Villers 
only  chronic  male  patients  who  require  little  oversight  and 
are  already  accustomed  to  farm-work.  Although  the  colony 
of  Villers  is  a  considerable  distance  from  that  of  Fitz-James, 
the  lands  adjoin.  The  open-door  system  is  here  fully  real- 
ized, the  operations  of  the  place  being  conducted  with  nearly 
the  same  liberty  as  in  ordinary  family  life. 

On  Sunday  many  of  the  patients  attend  mass  in  the 
village,  where  a  portion  of  the  church  is  set  apart  for  them. 
Some  are  trusted  to  go  alone  both  to  church  and  to  village 
festivals. 

The  examination  of  the  Clermont  colonies  aflorded  me 
much  satisfaction.  There  was  apparent  cheerfulness  in  the 
several  divisions,  while,  as  has  already  been  shown,  the 
steadiness  with  which  the  industries  are  pursued  tells  favor- 
ably in  the  economic  results  attained.  Nevertheless,  the 
primary  object  of  labor  is  the  welfare  of  the  patients.  The 
force  of  example,  the  fear  of  being  returned  to  the  more  re- 
stricted limits  of  the  central  asylum,  and  the  offer  of  rewards 


238  CONTINENTAL    COUNTRIES. 

in  the  shape  of  money  or  dainty  food  are  inducements  to 
labor  ;  but  recourse  to  coercion  is  forbidden.  On  an  aver- 
age, the  time  allotted  for  wofk  does  not  extend  beyond  six 
hours  per  day.  In  some  departments,  as,  for  example,  the 
laundry,  the  labor  is  performed  by  alternate  sets  of  workers. 
The  free  and  natural  conditions  of  life  existing  at  Fitz- 
James  and  Villers  are  marked  characteristics  of  these 
colonies,  nor  can  one  forbear  to  note  the  admirable  judgment 
and  delicate  tact  displayed  in  adjusting  the  employments 
to  the  experience,  physical  capacity,  and  mental  condition 
of  the  patient.  If  a  working  patient  betrays  symptoms  of 
violence  or  becomes  from  any  cause  unmanageable,  he  is 
immediately  transferred  to  the  central  asylum  ;  and,  on  the 
other  hand,  whenever  a  patient  in  the  central  asylum  be- 
comes quiet  and  tractable,  he  is  removed  to  the  colony  and 
its  industrial  system.  There  is  thus  a  steady  and  highly 
beneficial  intercourse  between  the  two  divisions.  With  all 
the  freedom  here  accorded,  surprising  as  it  may  appear, 
there  are  few  attempts  to  escape,  and,  indeed,  there  are  few 
casualties  of  any  description. 

The  satisfaction  derived  from  the  inspection  of  the  colo- 
nies of  Fitz-James  and  Villers  did  not  extend  to  the  central 
institut^ion  with  its  one  thousand  inmates.  Possibly  owing 
to  the  large  numbers  brought  under  one  management  and 
the  burdens  incident  to  the  conducting  of  its  extended 
business  affairs,  the  central  asylum  at  Clermont  did  not, 
as  it  appeared  to  the  writer,  reach  a  proper  standard  for 
a  hospital  for  the  treatment  of  the  acute  insane. 


CHAPTER  VI. 
THE  COLONY  OF  GHEEL. 

LEAVING  the  afternoon  train  from  Antwerp,  the  writer, 
accompanied  by  a  stenographer  familiar  with  the 
patois  of  the  place,  wended  his  way  for  about  half  a  mile 
along  a  street  or  roadway  sparsely  lined  with  plain  cottages 
to  one  of  the  two  principal  inns  of  Gheel.  A  few  steps  from 
this  humble  hostlery  brought  us  to  the  main  public  square,  at 
one  end  of  which  is  the  church  of  St.  Amand,  and  close  by  is 
a  lofty  cross  with  a  life-size  figure  of  our  Saviour.  On  the  re- 
maining three  sides  of  the  square  are  plain  houses  or  shops, 
none  of  which  exceed  two  stories  in  height.  Near  the  church 
is  a  huge  ancient-looking  pump  which  forms  a  rendezvous 
for  the  young  maids  and  children  of  the  town,  as  well  as  a 
centre  for  the  dissemination  of  gossipy  news.  The  farther 
end  of  the  green  was  covered  with  linen  of  the  villagers 
spread  out  with  great  particularity  to  bleach  upon  the  grass, 
indicating  the  methodical  habits  of  the  people.  A  number 
of  persons  having  the  appearance  of  being  insane  were  seen 
walking  along  the  street  or  seated  on  the  door-steps  of  the 
dwellings.  From  this  part  of  the  staid  old  town,  we  pro- 
ceeded along  a  winding  paved  road,  on  either  side  of  which 
were  brick  houses  with  red  tile  roofs,  receiving  on  our  way  re- 
spectful salutations  from  the  villagers.  A  novel  street  scene 
was  that  of  men  in  small  cars  which  were  drawn  by  dogs. 
The  first  car  noticed  had  five  of  these  animals  abreast;  to 
each  of  two  others  was  attached  a  pair  of  dogs.     Thus  far 

239 


240  THE   COLONY  OF  GHEEL. 

we  had  passed  a  number  of  small  shops  devoted  to  the  sale 
of  beer  and  tobacco.  About  an  eighth  of  a  mile  from  the 
square,  the  street  terminates  in  a  long  avenue  of  beautiful 
elms,  extending  far  into  the  country,  with  here  and  there,  on 
either  side,  larger  two-story  buildings  than  we  had  previously 
seen.  A  short  walk  along  this  avenue  brought  us  to  the  In- 
firmary, a  large  two-story  brick  structure  with  red  tile  roof, 
standing  amid  gardens  and  shrubbery.  Occupying  a  niche  in 
the  central  projecting  gable  of  this  building  is  a  life-size  figure 
of  St.  Dymphna,  the  patron  saint  of  Gheel.  Having  made 
an  appointment  for  the  following  morning  with  Dr.  Peeters, 
the  head  physician  and  director  of  this  institution,  we  took  a 
short  route  across  the  cultivated  patches  of  ground  and  soon 
reached  the  church  of  St.  Dymphna,  of  legendary  fame. 

This  church  is  a  massive  cruciform  structure,  chiefly  of 
brick,  with  portals  and  carved  mouldings  of  stone.  Within 
are  numerous  tombs  and  tablets,  and  the  walls  have  paint- 
ings and  other  decorations  in  keeping  with  the  sacred  char- 
acter of  the  place.  As  we  entered,  through  the  gathering 
shades  of  evening,  wc  descried  at  the  farther  extremity  a 
star-like  light  which  burns  unceasingly  at  the  shrine  of  the 
saint.  On  one  of  the  church  pillars,  near  the  altar,  is  a  cano- 
pied statue  of  St.  Dymphna,  and  opposite  to  it  on  the  corre- 
sponding pillar,  is  a  sculptured  figure  of  Father  Gerebernus, 
the  religious  guide  and  protector  of  the  maiden  saint.  The 
altar  of  white  marble  has  sculptured  representations  of  in- 
sane persons  with  manacled  limbs,  in  the  act  of  supplicating 
St.  Dymphna.  The  silver  shrine,  believed  to  contain  her 
relics,  is  elaborately  wrought,  and  is  preserved  with  religious 
care.  The  tomb  of  the  saint  is  elevated  on  short  pillars, 
but  sufficiently  high  to  admit  of  persons  passing  under  it 
upon  their  knees.  The  stone  pavement  about  it  is  much 
worn  by  the  feet    of    weary  pilgrims,  who,   through  many 


^ 


PECULIAR   CEREMONIES.  24I 

generations,  have  here  sought  relief  from  their  afflictions. 
On  the  walls  near  by  are  legendary  inscriptions  relating  to 
her  romantic  life. 

In  apartments  connected  with  the  church  and  under  the 
charge  of  a  resident  sacristan  is  a  goodly  sized  room  with  tile 
floor,  and  massive  beams  overhead.  On  each  side  of  a  large 
open  fire-place  are  iron  rings  in  the  wall  once  used  to  secure 
violent  patients  near  the  fire  without  endangering  them. 
Adjoining  this  room  is  one  not  so  large,  which  receives  light 
from  the  other  through  a  small  grated  window.  The  smaller 
room,  unoccupied  at  the  time  of  my  visit,  and  now  seldom 
used,  was  furnished  with  a  table  and  a  comfortable  bed.  Ac- 
cording to  Esquirol,  who  visited  Gheel  in  the  year  1821  :  "  It 
was  formerly  the  custom  for  a  patient  to  be  placed,  on  his 
arrival,  for  nine  successive  days  in  the  house  adjoining  the 
church,  along  with  a  few  others,  in  a  room  under  the  guard 
of  two  old  women.  A  priest  came  every  day  and  said  mass 
and  read  prayers  to  them.  Then  those  patients  who 
were  tranquil,  joined  by  some  children  of  the  place,  went 
three  times  in  procession  outside  and  as  often  inside  of  the 
church  during  the  nine  days  of  treatment.  Each  time  they 
arrived  at  the  tomb  of  the  saint  they  prostrated  themselves 
and  passed  under  it  on  their  knees.  If  a  patient  was  too 
furious  to  allow  of  this  being  done,  an  inhabitant  of  Gheel 
and  some  children  were  paid  to  perform  the  ceremony." 

However  incongruous  these  ceremonies  may  seem  as  com- 
pared with  our  present  theories  respecting  the  insane,  we 
may  not  treat  with  levity  the  simple  faith  of  those,  who, 
actuated  by  a  belief  in  spiritual  influences,  sought  relief  for 
themselves  or  suffering  friends  at  the  shrine  of  St.  Dymphna. 
The  pious  custodian  in  charge  of  the  church  lamented  the 
falling  off  in  the  number  of  pilgrims'  visits,  a  circumstance 
attributed  by  him  in  part  to  "  new-fangled  notions  of  the 


242  THE   COLONY   OF  CUE  EL. 

doctors."  Though  faith  in  the  heaHng  powers  of  the  saint 
is  weakened,  her  memory  is  still  honored  by  an  annual 
fete  held  in  the  month  of  May,  in  which  both  sane  and  in- 
sane take  part. 

Not  far  from  the  church  of  St.  Dymphna  stands  an  ancient 
hospital,  said  to  have  been  built  in  the  thirteenth  century. 
In  one  of  its  walls  is  a  covered  recess,  open  to  the  street, 
from  which  it  is  separated  by  iron  bars.  It  contains  two 
figures,  life-size  ;  one  representing  a  grim  warrior,  the  other, 
a  kneeling  and  suppliant  maiden  upon  whom  his  uplifted 
sword  is  descending.  These  figures,  it  was  said,  mark  the 
spot  where  the  saint  was  put  to  death. 

There  are  various  versions  of  the  interesting  legend  of  St. 
Dymphna,  and  among  them  the  following,  which  is  given 
substantially  as  related  to  us  by  an  accredited  cicerone,  who 
evinced  a  zealous  interest  in  all  that  affected  the  good  repu- 
tation of  his  native  town. 

In  the  seventh  century  there  lived  in  Erin  a  king  whose 
daughter,  like  her  mother,  had  acquired  fame  for  her  beauty  as 
well  as  her  many  virtues.  She  became  a  convert  to  Christianity, 
and  shortly  after  her  conversion,  her  father,  tempted  by  the  Evil 
One,  so  persecuted  his  daughter  by  his  unnatural  conduct  as  to 
drive  her  to  desperation.  She  took  counsel  of  an  aged  priest, 
the  holy  Gerebernus,  and  with  his  advice  and  assistance  secretly 
left  the  country  and  found  a  temporary  refuge  at  the  place  where 
Gheel  now  stands.  Here,  under  the  protection  of  Father  Gere- 
bernus, she  abode,  serving  God  by  fasting  and  prayer.  The 
king,  on  discovering  that  his  daughter  had  fled,  was  beside  him- 
self with  rage,  and  sought  her  everywhere  in  his  own  kingdom. 
Unsuccessful  in  these  efforts,  he  extended  his  search  to  other 
countries,  and  at  length  came  to  Antwerp,  where,  finding  some 
pieces  of  the  coin  of  his  own  realm,  they  afforded  him  a  clue, 
which,  with  bribery,  led  to  the  betrayal  of  her  secret  abiding- 
place.  Here  he  found  and  slew  Father  Gerebernus,  and  then, 
with  his  own  hand,  put  his  lovely  daughter  to  death.  God  pro- 
tected their  bodies  from  the  wild  beasts,  and  from  the  fowls  of 


THE  LEGEND   OF  ST.  DYMPHNA.  243 

the  air,  until  they  were  buried  by  the  people.  When  these  things 
were  told  about  the  country,  many  came,  or  were  brought,  to  the 
graves  of  the  martyrs,  and  were  cured  of  all  manner  of  diseases, 
bodily  as  well  as  mental,  but  particularly  the  latter. 

The  priests,  hearing  of  the  miracles  that  were  effected,  de- 
sired that  the  bodies  should  be  exhumed,  and  again  buried  with 
appropriate  ceremonies.  In  this  attempt,  they  were  astonished 
to  find  that  the  remains  of  Dymphna  and  Gerebernus  had  each 
been  inclosed  in  a  snow-white  stone  sarcophagus.  This  was  re- 
garded as  a  special  interposition  of  the  angels.  Afterward,  many 
came  from  afar  to  see  the  relics  of  the  holy  dead.  Among  these 
strangers  were  some  inhabitants  of  Xanten  on  the  Rhine,  who, 
after  remaining  several  days  at  Gheel,  meanly  stole  the  sacred 
relics  and  fled,  hotly  pursued  by  the  indignant  people  of  Gheel. 
Becoming  pressed  to  make  good  their  escape,  the  wicked  plun- 
derers relinquished  one  of  the  sarcophagi,  and,  by  mistake,  made 
off  with  the  remains  of  Father  Gerebernus,  leaving  the  coffin  of 
the  virgin  in  the  hands  of  their  pursuers.  Their  mistake  dis- 
covered, the  sacrilegious  villains  returned  and  made  an  attempt 
to  recapture  the  coffin  of  Dymphna,  when  lo  I  it  was  found  to 
have  become  as  immovable  as  the  rock  on  which  it  lay.  A  good 
frow,  prompted  by  a  heavenly  vision,  harnessed  her  young 
heifers,  and,  with  them,  drew  the  sacred  relics  back  to  Gheel, 
aided  by  some  and  mocked  by  others.  It  was  believed  that  the 
martyred  maiden  not  only  forgave  the  murderous  deed  of  her 
father,  believing  him  to  have  been  insane,  but  desired  to  alleviate 
a  like  madness  in  others.  Her  presence  was  proclaimed  at  the 
spot,  and  thither  afterward  pilgrims  came  imploring  her  interces- 
sion. Miraculous  cures  were  effected,  and  many  of  unsound  mind 
were  restored  to  reason  at  her  shrine. 

As  time  wore  on,  added  our  guide,  pilgrims  increasingly 
flocked  to  this  place,  and  out  of  their  gifts  a  chapel  was  at  first 
erected,  and  some  time  in  the  twelfth  century  the  present  church 
of  St.  Dymphna.  It  became  necessary  for  the  friends  of  patients 
to  find  in  the  neighborhood  permanent  boarding-places  for  the 
afflicted,  and  thus  was  established  the  colony  of  Gheel. 

THE    SURROUXDIXGS    OF    GHEEL. 

The  commune,  or  what  is  known  as  the  colony  of  Gheel, 
covers  a  territory  of   upwards   of    forty   square   miles.     Its 


244  THE    COLONY  OF  GHEEL. 

greatest  length  is  about  eleven  miles,  and  its  greatest 
breadth  a  little  short  of  nine  miles.  The  colony  contains 
about  three  thousand  houses,  in  more  than  one  third  of 
which  lunatics  are  boarded.  The  public  affairs  of  the  com- 
mune are  presided  over  by  a  Burgomaster.  A  sluggish 
stream,  called  the  Greater  Nethe,  flows  through  the  flat 
country,  in  the  midst  of  which  it  is  situated.  The  town 
proper,  which  partakes  of  the  character  of  a  straggling  vil- 
lage, is  centrally  located  in  the  commune,  over  which,  at 
intervals,  are  scattered  hamlets,  while  the  whole  area  of  the 
country  is  dotted  with  farm-houses,  having  very  small  culti- 
vated farms  or  garden  fields  attached.  The  soil  is  generally 
suitable  for  gardening,  and  for  the  most  part  fairly  pro- 
ductive, though  in  some  portions  light  and  sandy.  Every 
available  foot  of  land  is  under  tillage,  not  even  a  path  along 
the  wayside  being  left  uncultivated,  and  often,  on  other  than 
the  principal  roads,  there  is  scarcely  driving  space  between 
the  fields.  The  parish  church  of  St.  Amand  and  that  of  St. 
Dymphna  form  two  central  points  of  settlement,  between 
which  is  the  main  business  street  of  the  town,  extending  a 
distance  of  three  eighths  of  a  mile.  In  addition  to  the  long 
straight  avenue  previously  referred  to,  there  are  several  oth- 
ers of  modern  appearance  ;  but  aside  from  these,  the  whole 
country  about  Gheel  is  a  tangled  web  of  roads  and  lanes, 
along  w^hich,  at  intervals,  are  farm  cottages. 

In  no  part  of  the  colony  is  there  evidence  of  opulence, 
or,  indeed,  of  any  thing  more  than  middle-class  comfort. 
Nearly  all  the  towns-people  are  farmers  in  a  small  way, 
frugal  and  industrious.  Many  of  them  keep  little  other 
stock  than  a  couple  of  cows,  and,  besides  raising  enough  to 
supply  their  own  wants,  eke  out  a  rent  with  what  they  re- 
ceive for  boarding  and  attending  to  the  insane.  The  women 
are  not  less  industrious  than  the  men.     It  is  no  uncommon 


IND  US  TRIES — POP  ULA  TION.  245 

sight  to  see  females  at  work  in  the  fields,  or  driving  dogs 
harnessed  to  cars.  It  is  estimated  that  some  three  hundred 
or  four  hundred  women  are  engaged  in  this  place  at  lace- 
making,  their  day's  work  of  twelve  hours  yielding  them 
barely  a  franc.  In  the  town  are  several  tobacco  factories 
and  two  breweries.  What  was  formerly  a  paper  factory, 
employing  one  hundred  hands  in  the  manufacture  of  colored 
paper  for  the  English  market,  was  pointed  out  to  us.  It 
had  succumbed  to  the  pressure  of  rival  interests. 

It  may  be  well,  for  purposes  of  comparison,  and  for  the 
better  comprehension  of  what  follows,  to  give  here  a  few 
statistics  relating  to  the  insane  in  Gheel  at  different  periods 
since  the  latter  part  of  the  eighteenth  century,  when  the 
number  was  about  four  hundred. 


Year. 
1803 
1812 
1821 
1840 

1855 
1868 
1869 


Patients. 

Year. 

600 

1870 

500 

1871 

400 

1873 

717 

1874 

778 

1876 

1,035 

1880 

1,072 

1885 

Patients. 

1,095 
1,127 
1,230 
1,272 

1,383 
1,630 

1,653 


Prior  to  1803,  there  was  no  organized  governmental  con- 
trol, nor  any  regular  system  of  inspection  of  the  insane. 
The  commune,  comprising  eight  parishes,  each  having  a 
church,  has  nearly  12,000  inhabitants,  of  whom  about  5,000 
live  in  the  town.  The  proportion  of  insane  is  about  one  to 
seven  of  the  whole  population  of  the  colony. 

THE    INFIRMARY    AND    ITS    FUNCTIONS. 

The  infirmary  fulfils  the  functions  of  a  central  asylum,  or 
"  observation  "  station,  through  which  all  cases  received  into 
the  colony  must  pass,  and  to  which  are  returned  such  as  are 
found  unsuited  to  family  life,  previous  to  their  being  sent 


246  THE    COLONY   OF   GHEEL. 

elsewhere  for  asylum  care.  It  serves  also  as  a  hospital  for 
such  of  the  insane  as  require  medical  treatment,  and  provides 
for  those  who  are  subject  to  periodical  paroxysms.  This,  as 
also  the  whole  of  the  boarding-out  system  of  the  colony,  is 
under  the  direction  of  a  Board  of  Commissioners,  including 
the  Governor  of  the  Province,  the  Judge  of  the  Canton,  the 
Burgomaster,  the  King's  Procurator,  a  physician  appointed 
by  the  Government,  and  two  members  chosen  by  the  Minis- 
ter of  Justice.  This  Commission  has  supervision  of  all 
matters  relating  to  the  general  care  of  the  patients,  and 
makes  a  yearly  report  to  the  Government.  There  is,  in 
addition  to  this,  a  permanent  committee  upon  which  de- 
volves the  enforcement  of  the  regulations  respecting  lunatics 
in  the  colony.  The  commune  and  the  medical  staff  of  the 
colony  arc  represented  upon  this  committee,  of  which  the 
Burgomaster  is  chairman.  The  committee  meet  once  a 
week,  to  decide  as  to  the  eligibility  of  new  arrivals,  and  as 
to  their  distribution  in  the  colony.  They  likewise  receive 
and  pay  out  money,  and  adjudicate  upon  the  qualifications 
of  all  applicants  for  the  boarding  of  the  insane.  For  the 
latter  purpose  a  registered  list  is  kept  of  all  who  wish  to  re- 
ceive patients.  The  Secretary  of  the  committee  and  of  the 
Commission  also  acts  as  steward  of  the  infirmary. 

The  district,  or  commune,  is  divided  into  two  medical  sec- 
tions, each  of  which  is  in  charge  of  a  chief  physician  assisted 
by  a  second  medical  officer.  The  time  of  these  sectional 
physicians  is  not  wholly  devoted  to  the  insane,  as  they  have 
also  a  private  practice.  The  Medical  Director  of  the  colony, 
Dr.  Peetcrs,  is  charged  with  the  duty  of  general  visitation 
and  inspection.  The  sectional  physicians  or  their  assistants 
are,  by  rule,  required  to  visit  every  one  of  their  patients  once 
a  month,  and  troublesome  cases  whenever  necessary.  Acute 
cases  are  visited    at    least  once    a  week.     Before   1879  ^^^ 


DISTRICT  INSPECTORS.  247 

doctors  of  the  sections  were  not  required  to  visit  their  pa- 
tients oftener  than  three  or  four  times  a  year.  In  addition 
to  the  medical  supervising  ofiRcers  there  are  iowx  gardes,  or 
inspectors,  appointed  by  the  Minister  of  Justice,  each  hav- 
ing an  assigned  district.  These  are  charged  with  the  duty 
of  visiting  the  patients  boarded  out  and  examining  their 
dietary,  clothing,  and  bedding,  and  inquiring  into  whatever 
relates  to  their  proper  care  or  treatment.  They  also  take 
charge  of  the  transfer  of  patients  to  and  from  the  infirmary. 
In  addition  to  the  four  district  inspectors  two  others  are 
stationed  at  the  infirmary,  who  act  under  the  direction  of 
the  Medical  Superintendent.  Each  district  inspector  is  re- 
quired to  see  every  patient  within  the  district  assigned  him 
once  a  fortnight,  and  he  is  subject  to  call  at  any  time,  in 
case  of  violent  outbreaks,  or  where  restraint  is  necessary. 
He  reports  daily  to  the  head  physician  ;  and  his  visits  to  the 
patients,  as  well  as  those  of  the  medical  men,  are  duly  re- 
corded in  register-books,  which  are  kept  in  the  houses  where 
the  patients  board.  In  these  books  are  inserted  particulars 
of  the  name,  age,  etc.,  of  each  patient,  as  well  as  a  note  of 
the  clothing  received  from  the  infirmary.  Besides  the  ofili- 
cials  already  mentioned,  there  are  in  attendance  at  the  in- 
firmary five  Sisters  rcligieusc  of  the  order  of  the  Norbertines. 
There  are  also  three  male  attendants. 

The  infirmary  is  a  plain,  but  substantial  structure,  with  a 
capacity  to  accommodate  about  one  hundred  inmates. 
Attached  to  the  institution  are  five  acres  of  ground.  The 
insane  inmates  at  the  time  of  my  visit  numbered  twenty-six 
males  and  twenty  females.  The  two  wings  of  the  infirmary 
are  built  on  a  similar  plan,  each  embracing  three  depart- 
ments— the  first  being  for"  quiet,"  the  second  for  "  partially 
disturbed,"  and  the  third  for  "  disturbed  "  patients.  The  men 
and  women  occupy  different  sides  of  the  building,  both  be- 


248  THE   COLONY  OF  GHEEL. 

ing  supplied  with  food  from  a  common  kitchen.  Each  de- 
partment contains  a  dining-room,  small  hospital,  and  inner 
court.  In  each  of  the  courts  was  a  large  dove-cot,  erected 
on  a  high,  central  post,  for  the  entertainment  of  the  insane. 

The  isolating  cells,  of  which  there  were  seven  for  men  and 
seven  for  women,  contained  wooden  bedsteads  of  box  pat- 
tern, with  head  and  foot  boards,  and  each  was  provided  with 
a  chair.  The  floors  are  of  wood.  A  hall  or  corridor  extends 
on  either  side  of  the  range  of  cells,  which  are  tolerably  well- 
lighted,  and  warmed  by  stoves  from  the  outside.  One  cor- 
ridor is  used  for  domestic  work,  the  other  for  observation  of 
the  patients.  A  window,  the  gratings  of  which  form  geomet- 
rical figures,  opens  into  one  of  the  halls.  There  is  a  solid- 
panelled  door  to  each  cell.  Each  of  these  small  rooms  has 
openings  to  facilitate  ventilation.  In  a  corner  of  the  room 
is  a  tin  or  iron  night-vessel  of  peculiar  pattern,  fitting  close 
against  the  seat,  and  accessible  for  removal  only  from  the 
outside.  In  the  third  division  there  are  in  addition  cells 
of  similar  construction  to  those  described,  with,  however, 
stronger  gratings.  There  was,  on  either  side,  a  padded 
room  ;  but  these,  it  was  said,  were  seldom  used. 

There  were  on  the  men's  side  some  iron  bedsteads  thirty- 
three  inches  wide,  with  panels  grained  to  resemble  wood. 
Fastened  to  the  bottom  of  each  of  these  bedsteads  was 
a  plate  of  galvanized  iron,  about  three  feet  long,  with  a 
depression  converging  to  a  central  aperture  leading  to.  a 
metallic  drawer-like  receptacle  underneath.  The.  side-pieces 
of  the  bedstead,  ten  inches  deep,  were  made  of  sheet-iron, 
with  the  edges  strengthened  by  thin  iron  bars.  On  each 
side  were  three  loops,  used,  when  necessary,  in  connection 
with  a  restraining  apparatus.  The  bottom  mattress  of  the 
bed  was  made  in  three  sections. 

In   connection  with  a  room  for  the  sick   was  a  spacious 


k 


MECHANICAL   RESTRAINT.  249 

porch  inclosed  with  glazed  sash,  and  having  a  glass  roof  to 
admit  sunlight. 

Dr.  Peeters  said  it  had  been  found  impracticable  to  dis- 
pense with  mechanical  restraint.  The  appliances  in  use  were 
as  follows:  i.  A  broad  padded  belt,  or  band,  five  inches 
wide,  for  locking  around  the  upper  part  of  the  arm.  In  this 
belt  is  an  iron  loop  through  which  passes  a  strap  for  secur- 
ing the  patient  to  the  side  of  the  bed.  This,  we  were  told, 
could  be  used  without  accident,  however  much  the  patient 
might  struggle.  2.  Two  padded  leather  bands  three  inches 
broad,  connected  in  the  centre  by  a  link  two  inches  long. 
These  are  designed  for  the  ankles  of  the  patient.  To  each 
is  attached  a  loop  of  iron  through  which  a  strap  is  passed 
and  fastened  to  either  side  of  the  bedstead.  3.  Two  padded 
soft  leather  wrist-bands,  three  inches  wide,  separating  the 
wrists  about  eight  inches.  Dr.  Peeters  said  these  were 
scarcely  ever  used.  4.  A  broad  leather  belt  for  encircling 
the  body,  with  two  leather  pockets  in  front  for  the  hands, 
which  are  secured  in  their  position  by  wristlet-straps.  Ex- 
tending from  this  belt  across  the  shoulders,  suspender  fashion, 
are  straps  which  retain  in  position  and  relieve  the  weight  of 
the  belt,  which  locks  at  the  back.  This,  familiarly  known  as 
la  ccinture  a  bracelets  mobiles,  was  said  to  be  preferred  by  the 
patients  to  the  camisole,  and  was  spoken  of  as  "  particularly 
useful  for  such  as  incline  to  tear  their  clothing."  It 
should  be  stated  that  I  saw  no  patients  wearing  any  of 
these  contrivances  during  my  inspection  of  the  infirmary. 

THE  "  HUTES  "  AND  "  NOURRICIERS." 

The  need  of  some  kind  of  governmental  supervision  and 
control  over  the  insane  at  Gheel  became  manifest  at  an  early 
period.  From  the  past  history  of  the  colony  it  appears  that, 
at  the  beginning  of  the  present  century,  the  "  trade  "  inter- 


250  THE   COLONY  OF  GHEEL. 

est  of  the  peasantry,  and  of  the  communal  administration  in 
the  keeping  of  the  insane,  assumed  an  objectionable  form. 
The  local  administration  exercised  a  sort  of  favoritism  in 
allocating  the  patients  boarded  out,  and  the  favored  care- 
takers, in  return,  submitted  to  a  tax  on  their  land  or  busi- 
ness. Eventually,  as  numbers  increased,  and  the  public 
became  more  enlightened  on  the  subject,  the  communes  send- 
ing patients  to  Gheel,  resolved  also  to  send  delegates,  or 
inspectors,  charged  with  the  duty  of  watching  over  the 
welfare  of  those  whom  the  authorities  had  consigned  to 
colonial  care.  Dr.  Parigot,  who  was  appointed  to  represent 
Brussels  in  this  capacity,  states  that  when  inspectors  were 
first  appointed,  in  1803,  the  treatment  of  lunatics  at  Gheel 
was  perhaps  even  more  cruel  than  that  of  the  negroes  he 
had  seen  in  South  America. 

Under  the  legislative  reform  of  1850  the  control  and  ad- 
ministration of  the  colony,  so  far  as  it  related  to  the  insane, 
passed  from  the  communal  authorities  to  the  State  govern- 
ment, and  the  changes  then  made  and  those  effected  by  the 
law  of  185 1,  led  eventually  to  the  erection  of  the  infirmary 
building,  which  was  opened  in  1862.  Previous  to  185 1  the  sys- 
tem in  operation  in  the  colony  was  not  free  from  reprehensible 
practices.  Severe  forms  of  restraint  were  then  in  use.  Dr. 
Pliny  Earle  relates  that,  during  his  visit  to  Belgium  in  1849, 
he  observed  "a  patient  in  the  streets  of  Gheel,  with  his  waist 
encircled  in  an  iron  belt,  to  which  his  hands  were  secured  by 
wristlets,"  and  that  "  in  the  suburbs,  and  among  the  farm- 
houses, several  were  fettered  with  iron,  the  chain  between 
the  ankles  being  about  eight  inches  in  length,  while,  in  some 
cases,  the  rings  round  the  ankles  had  abraded  the  skin  and 
occasioned  bad  ulcers."  The  appointment  of  Dr.  Bulckens 
as  director,  in  1856,  brought  about  the  gradual  abolition  of 
these  unnatural  methods  of  restraint.     Since  then  the  treat- 


NOTES    AND  NOURRICIERS.  251 

ment  has  been  of  a  more  humane  character.  During  the 
whole  period  of  my  visit  I  did  not  see  a  single  patient  under 
any  form  of  mechanical  restraint. 

The  colony  is  open  to  certain  classes  of  the  insane  for  whose 
board  compensation  is  made.  In  the  case  of  private  patients 
the  price  is  arranged  by  special  contract  with  those  residents 
of  the  commune  whose  names  are  on  the  registered  list  al- 
ready referred  to,  and  who  are  approved  by  the  permanent 
committee,  as  persons  likely  to  give  proper  attention  to  the 
insane  committed  to  their  care.  No  house,  unless  by  special 
privilege,  is  allowed  to  have,  at  one  time,  more  than  two  in- 
sane patients.  The  law  excludes  the  homicidal,  suicidal,  and 
incendiary,  those  requiring  continual  restraint,  and  others  un- 
fit for  family  care.  If  a  case  is  decided  by  the  committee  to  be 
unsuitable,  the  patient  is  returned  to  the  committing  party. 
About  ten  per  cent  of  each  year's  arrivals  are  so  returned. 
More  women  are  usually  received  than  men.  The  patients  are 
chiefly  from  the  provinces  of  Brabant,  Anvers,  and  Liege. 
There  are  a  few  from  foreign  countries.  It  appears  that  the 
increasing  numbers  of  the  insane  have  created  a  pressure 
upon  asylum  accommodation  throughout  the  whole  of  Bel- 
gium, causing  a  greater  demand  for  cottage  provision  at 
Gheel. 

At  the  time  of  my  visit  there  were  in  the  commune  about 
238  private  boarders,  ox pcnsionnaires,  as  they  are  called,  who 
were  kept  at  prices  arranged  with  the  hote.  This  is  a  term  ap- 
plied to  those  who  keep  paying  patients  ;  those  having  paupers 
are  termed  noiirricicrs.  A  few  of  these  paying  boarders  were 
received  at  as  high  as  3,000  francs  each  per  annum,  about 
thirty  were  boarded  at  1,200  francs  each,  and  two  hun- 
dred at  400  francs  each.  About  forty  of  the  private 
boarders  were  foreigners.  The  paupers  numbering  1,400 
were  received  by  noiirriciers  at  charges  fixed  annually  by  the 


252  THE   COLONY  OF  GHEEL. 

Government.  There  are  three  classes  of  pauper  patients. 
The  first,  designated  as  "  ordinaires,''  are  those  who  are  in  fair 
physical  health  and  who  are  able  to  make  themselves  useful 
to  some  extent ;  the  second,  the  ^^ seini-gdteiix,''  are  those  who 
can  do  a  little  work  and  are  at  times  uncleanly  ;  the  third, 
the  " gdteux,''  are  those  who  can  do  no  work  and  are  un- 
cleanly in  their  habits.  The  rates  payable  per  annum  for 
each  patient  belonging  to  these  different  classes  were,  for 
the  first  class,  219  francs;  for  the  second,  255  francs;  and 
for  the  third,  313  francs. 

A  certain  percentage  of  the  money  received  for  boarding 
patients  is  reserved  by  the  Government  to  meet  the  expenses 
of  medical  care,  supervision,  medicines,  and  clothing,  and 
for  maintaining  the  infirmary.  The  tax  is  so  adjusted  as  to 
amply  meet  the  expenditures  made  for  these  purposes,  and 
varies  in  different  years.  The  sum  reserved  from  the  pay- 
ment made  for  each  pauper  patient  the  year  preceding  my 
visit,  for  administration  expenses,  medicines,  supervision, 
etc.,  was  9  centimes  per  day,  and  for  clothing,  10  centimes, 
making  a  total  of  19  centimes  per  day,  or  69  francs,  35  cen- 
times per  annum.  Medicines  are  prescribed  by  the  doctors 
and  supplied  by  the  apothecaries  of  the  colony  at  fixed  rates. 

Since  my  visit  the  prices  paid  by  communes  for  the  board 
of  indigent  patients  have  been  advanced  so  that  the  per- 
capita  rate,  including  governmental  supervision,  medical 
visitation,  medicine,  and  clothing,  is,  iov  t\\Q '' ordinaires,"' 
$1.09,  for  the  "  sevii-gdteiix,''  $1.22,  and  for  the  ^^ gdtcux," 
$1.43  each  per  week.  The  average  cost  of  maintaining  ordi- 
nary patients  in  asylums  for  the  insane  in  Belgium  is  esti- 
mated at  $1.55  per  capita  per  week. 

When  a  boarding-house  keeper  is  unwilling  to  retain  a 
patient  on  account  of  violence,  or  for  any  other  cause,  the 
matter  is  brought  before  the  visiting  inspector,  or  garde  de 


INSPECTIONS  IN   TOWN.  253 

section,  who  reports  to  the  director,  and  an  order  is  made  for 
removal  to  the  central  station,  until  provision  is  made  else- 
where for  the  reception  of  the  case.  Such  removals  are  fre- 
quently effected,  and  it  often  happens  that  patients  are 
transferred  from  one  house  to  another  in  the  colony. 

VISITATION    OF    THE    TOWN    DWELLINGS. 

The  primary  aim  of  the  writer  in  visiting  Gheel  was  to 
make  an  examination  of  the  condition  of  the  insane  in  their 
cottage  homes.  By  courtesy  of  the  chief  physician,  a  guide 
was  furnished  who  was,  at  the  time,  one  of  the  district  in- 
spectors, and  who  had  been  for  many  years  in  the  service  of 
the  institution.  The  succeeding  days,  which  were  spent  in 
the  company  of  this  intelligent  ofificial,  were  wholly  taken 
up  in  going  from  house  to  house,  and  from  cottage  to 
cottage,  first  through  the  town  and  afterward  into  the  sur- 
rounding country.  As  we  set  out  upon  our  tour,  we  met 
upon  the  street  two  well-dressed,  middle-aged  persons  of 
gentlemanly  appearance,  who,  after  saluting  us,  held  a  few 
minutes'  conversation  with  our  guide.  But  for  a  casual 
remark  from  him,  we  probably  should  not  have  observed 
that  they  were  insane. 

It  has  already  been  shown  that  there  is  considerable  differ- 
ence in  the  charges  for  board.  There  is  equal  diversity  in  the 
character  of  the  houses  and  their  accommodation.  Between 
the  low,  thatched  house  with  mud  walls,  or  the  one-story 
building  with  attic-loft  occupied  by  the  pauper  class,  and  the 
more  inviting  and  more  commodious  two-story  dwelling  with 
plastered  exterior,  Avhere  reside  the  higher-paying  patients, 
there  are  various  grades  of  buildings.  In  the  humbler 
dwellings  of  the  town  one  generally  enters  the  principal 
apartment  of  the  house,  which  serves  the  various  purposes 
of  kitchen,  sitting,  dining,  and  reception  room.     In  some  of 


254  THE   COLONY  OF  GHEEL. 

the  houses  the  floors  of  these  apartments  are  on  a  level 
with  the  street  ;  in  others  they  are  even  lower,  and  there 
were  numerous  indications  of  dampness.  The  fuel,  of  which 
less  is  required  than  in  colder  climates,  consists  here  mainly 
of  bituminous  coal,  which  gives  a  clear  bright  fire.  The 
water  is  obtained  from  wells.  The  streets  have  surface 
drainage.     House  slops  are  used  to  irrigate  the  garden. 

Provided  with  a  map  of  the  commune,  we  proceeded  to 
inspect  some  of  the  town  dwellings.  At  the  outset,  permis- 
sion was  kindly  given  us  to  choose  from  the  entire  colony 
the  houses  and  localities  to  be  visited. 

Our  attention  was  first  turned  to  one  of  the  better  class 
of  the  town  houses — a  goodly  sized,  convenient,  two-story 
structure.  Here  resided  two  patients.  One  of  these,  an 
English  architect,  had  gone  out.  In  his  room  were  evidences 
that  he  employed  part  of  his  time  in  drawing.  Some  studies 
from  nature  showed  considerable  skill  in  execution,  as  did 
also  some  sketches  of  a  humorous  character.  The  apartments 
were  clean  and  comfortable.  The  sitting-room,  which  was 
used  by  both  patients,  was  furnished  with  a  sideboard,  mirror, 
and  a  few  pictures.  On  the  centre  of  the  floor  was  a  rug. 
The  adjoining  dining-room,  with  sanded  tile  floor,  also  showed 
some  taste,  being  hung  with  suitable  pictures.  Each  of  the 
two  patients  paid  1,200  francs  a  year  and  provided  his  own 
clothing.  Wc  have  mentioned  that  the  architect  patient 
was  out.  His  companion,  a  man  of  solitary  habits,  was  still 
in  bed,  although  the  hour  was  ten  o'clock.  The  architect's 
sleeping  apartment,  commanding  a  front  view,  had  a  wooden 
floor,  and  was  furnished  with  fur  rugs  and  ordinary  bedroom 
furniture.  The  window  and  French  bedstead  were  curtained. 
Here  were  all  the  needed  comforts,  as  well  as  some  of  the 
elegancies  of  life. 

On  the  opposite  side  of  the  street  was  a  beer  saloon,  and 


A   MUSICAL   SOCIETY.  255 

next  to  this,  a  spacious  concert  hall,  in  which  a  musical  so- 
ciety held  its  meetings.  Four  or  five  of  the  members  of  this 
society  were  patients,  one  of  whom  was  the  leading  violinist 
of  the  orchestra.  The  hall  was  fitted  with  galleries,  and 
lighted  with  large  chandeliers.  The  other  furnishing  com- 
prised many  small  tables  and  numerous  chairs.  This  con- 
cert-room opened  rearward  into  a  small  pleasure  garden. 
The  usual  entrance  to  the  hall  was  through  the  beer  saloon. 
The  director  of  the  musical  society  was  also  proprietor  of 
the  beer  house,  and  one  of  the  insane  boarded  with  him  pay- 
ing 1,000  francs  per  annum.  This  patient  made  himself 
quite  useful  about  the  hall. 

In  the  front  part  of  the  next  two-story  building  visited 
was  a  small  shop,  and  in  the  rear  of  it  a  parlor,  in  which  were 
two  boarders.  At  the  head  of  a  narrow  steep  staircase, 
closed  at  the  top  by  a  trap-door,  was  a  small  front  bedroom. 
Here  was  a  French  bedstead  of  box  pattern.  The  bed  was 
good,  but  not  very  clean.  There  were  also  in  the  room  a 
chair,  wash-stand,  and  rug  before  the  bed.  The  second 
bedroom,  with  an  outlook  to  the  rear,  contained  a  bed, 
chest,  wash-stand,  stove,  and  garments  hung  on  hooks. 
The  foot-board  of  the  bed  had  been  broken  by  the  violence 
of  the  patient.     The  house  was  small. 

Passing  to  the  adjoining  cottage,  we  found  a  reception- 
room  with  a  clean  tile  floor.  The  furnishing  was  plain  but 
appropriate,  and  there  were  flowers  in  the  window.  Here 
was  heard  the  homely  tick  of  the  old-fashioned  clock  on  the 
kitchen  wall.  Altogether  the  accommodation  was  good,  but 
the  stairs  were  steeper  and  narrower  even  than  those  last 
mentioned — seeming  to  be  positively  dangerous.  The  bed- 
room contained  a  French  wooden  bedstead,  with  blankets 
clean  and  comfortable,  and  a  feather  pillow  over  another 
of  wool.     The  window  was  of  medium  size  and  crated  with 


256  THE   COLONY  OF  GHEEL. 

bars  about  six  inches  apart.  A  wardrobe  and  a  closet  were 
in  the  room  and  a  rug  was  before  the  bed.  In  the  second 
sleeping-room  the  bed  was  good,  the  bare  floor  was  clean, 
and  the  walls  were  white.  The  window  was  without  grating. 
Both  were  back  rooms,  having  outlooks  upon  a  neatly  kept 
garden  and  the  country  beyond.  The  patients  here  paid  600 
francs  each  per  annum.    The  whole  house  seemed  tidily  kept. 

The  floor  of  the  kitchen  in  the  next  one-story  cottage 
entered  was  sanded.  Food  was  cooking  in  the  old-fashioned 
fire-place.  Every  thing  here  was  very  plain.  The  only  pa- 
tient, an  insane  man,  was  preparing  potatoes  for  dinner,  the 
other  members  of  the  household  being  out  in  the  fields.  We 
were  told  that  he  was  of  an  affectionate  disposition,  and  that 
when  a  child  of  the  family  died  a  short  time  previous,  his 
grief  was  inconsolable.  The  plates  and  furniture  were  clean, 
the  kettles  very  bright,  and  the  whole  interior  indicated 
good  housewifery.  Off  the  kitchen  was  a  moderate-sized 
bedroom  for  the  patient,  who  paid  255  francs  per  annum. 
The  window  of  this  room  had  wooden  slats.  The  bedstead 
was  of  the  box  pattern,  and  the  bedding  sufficient. 

The  next  house  and  the  last  mentioned  were  under  the 
same  roof,  and  their  accommodation  and  housekeeping  were 
similar.  In  the  day-room  or  kitchen  an  epileptic  patient  sat  in 
a  corner  behind  a  table,  with  a  chair  in  front  of  her.  The 
housewife  was  busy  preparing  cabbage  for  dinner  in  the  same 
apartment.  In  the  old-fashioned  fire-place  was  a  stove.  The 
rafters  showed  overhead.  In  the  adjoining  room  was  an  iron 
box-bedstead.  The  bedding,  including  two  pillows,  was  clean 
and  comfortable.  The  tile  floor  was  sanded.  The  window, 
2  X  3|-  feet,  had  hinged  sash,  and  was  protected  by  three 
bars.  In  a  corner,  under  a  bench,  was  a  heap  of  sand  for  use 
on  the  floor.  There  were  two  chairs  here,  and  the  clothing 
was  hun":  on  nails. 


LACE-MAKING.  257 

As  already  indicated,  lace-making  is  one  of  the  leading 
industries  of  Gheel.  In  some  instances  this  is  carried  on  in 
houses  where  patients  board.  An  example  of  this  came 
under  notice  in  the  next  house  visited,  where  three  girls — 
not  insane — were  thus  engaged.  It  was  said  that  the  female 
insane  are  sometimes  serviceable  in  this  occupation.  One 
of  two  patients  here,  a  young  woman,  was  seen  walk- 
ing about  outside.  She  complained  that,  as  she  spoke 
nothing  but  French,  she  could  neither  understand  nor  be 
understood  by  the  household,  all  of  whom  were  Flemish. 
Attractive  in  face  and  figure,  and  evidently  of  an  erotic 
disposition,  she  did  not  seem  suited  to  the  large  degree  of 
liberty  granted  her.  When  in  good  humor,  she  was  said 
to  be  an  active  worker.  The  second  patient  sat  in  the 
kitchen,  and,  it  was  said,  did  no  work.  Both  were  suit- 
ably dressed,  but  wore  wooden  shoes.  The  bedrooms  were 
tidy,  and  without  gratings  or  other  security  at  the  windows. 
One  of  the  patients  slept  down-stairs,  the  other  in  an  attic. 
The  stairs  were  both  narrow  and  steep. 

The  adjoining  dwelling  had  better  accommodations  than 
the  one  last  inspected.  The  housekeeping  was  of  about 
the  same  standard.  The  mid-day  meal  had  just  been  placed 
upon  the  table.  There  was  a  plate,  cup,  fork,  and  spoon  for 
each  member  of  the  household.  An  iron  dish  in  the  centre 
of  the  table  contained  the  food,  which  was  served  out  with 
a  ladle.  Two  patients  sat  waiting  for  dinner.  One  had  a 
plate,  spoon,  and  fork  in  her  lap.  It  was  stated  that  she 
made  herself  useful  peeling  potatoes.  Her  companion  did 
no  work.  On  the  lower  floor  was  the  bedroom  of  one  of  the 
patients,  which  was  of  fair  size,  and  contained  a  bedstead  of 
box  pattern  with  plenty  of  bedding.  The  tile  floor  was 
sanded,  but  it  was  not  quite  clean.  The  window  had  three 
bars.     At  one  end  of  the  attic  was  a  small  bedroom  occupied 


258  THE   COLONY  OF  GHEEL. 

by  the  other  patient.  Here  was  a  box-pattern  bedstead,  and 
apparently  sufficient  bedding,  though  the  surroundings 
were  those  of  poverty.     The  stairs  were  dangerously  steep. 

The  resident  proprietor  of  the  next  house,  who  was  not 
engaged  in  business,  had  returned  to  Gheel  after  a  nine 
years'  sojourn  in  America.  His  two-story  building,  with  red 
tile  roof,  had  been  recently  erected,  and  evidenced  the  im- 
proved fortune  of  its  owner.  Here  were  two  private 
patients,  paying  respectively  1,400  francs  and  1,000  francs 
per  annum.  One  of  the  bedrooms  was  furnished  with  a 
French  mahogany  bedstead,  very  good  bedding,  rug,  up- 
holstered chairs,  table,  wash-stand,  etc.  The  other  bed- 
room, fully  carpeted,  contained  a  mahogany  bureau  and  look- 
ing-glass. A  commodious  front  room,  well-furnished,  was 
used  as  a  sitting-room  by  the  patients,  as  well  as  by  the 
family.  The  interior  woodwork  of  the  house  was  painted ; 
the  walls  were  papered ;  and  the  apartments,  including 
the  bedrooms,  were  lighted  by  large  windows  without 
gratings  or  other  restrictions.  The  whole  interior  was 
tidily  kept,  and  the  atmosphere  was  pure.  In  short,  the 
surroundings  of  the  patients  were  seemingly  all  that  could 
be  desired.  The  character  of  the  housekeeping  was  in- 
dicated by  snow-white  curtains  and  spotless  linen.  One 
patient,  who,  it  was  said,  gave  no  trouble,  had  just  gone  out 
to  a  neighboring  inn  for  a  glass  of  beer.  He  had  formerly 
been  a  journalist  in  Switzerland.  His  companion,  who  was 
out  walking  in  the  back  garden  of  the  house,  was  said 
to  be  at  times  troublesome,  giving  many  orders  and  causing 
annoyance.  They  breakfasted  at  7  A.M.,  dined  from  12  to  i 
P.M.,  had  coffee  at  3  l>.M.,  and  supper  at  7  P.M.  The  diet 
was  varied,  and  the  patients  were  humored  in  their  choice 
of  food  as  far  as  possible. 

A  large  mansion,  built  close  to  the  street,  cannot  fail  to 


DR.    BULCKENS.  259 

arrest  the  attention  of  the  visitor  to  Gheel.  This  was 
formerly  the  residence  of  Dr.  Bulckens,  through  whose 
humanitarian  efforts  in  the  capacity  of  head  director  great  re- 
forms were  accomplished  throughout  the  colony,  and  whose 
lamented  death  occurred  in  1876,  The  house  was  occupied 
by  his  daughter,  who  received  two  patients  of  the  highest 
class.  The  broad  central  hall  of  this  mansion,  paved  with 
black  and  white  marble,  opened  into  grounds  at  the  rear  in 
which  were  flowers,  shade-trees,  and  convenient  seats.  The 
furnishings  of  the  reception,  sitting,  and  other  rooms  were  in 
good  taste.  A  large  parlor  on  the  ground-floor  was  assigned 
to  one  of  the  patients.  The  richly  carved  bedstead  and  other 
mahogany  furniture  were  highly  polished,  and  among  the 
various  ornamental  objects  was  a  vase  containing  a  luxuriant 
ivy.  The  patient  who  used  this  apartment  was,  at  the  time 
of  my  visit,  in  the  kitchen,  where  he  was  having  a  cup  of 
coffee  after  dinner.  The  upper  bedrooms  and  other  portions 
of  the  house  were  furnished  on  a  similar  scale  of  comfort  and 
elegance.  One  of  the  patients,  an  Englishman,  was  said  to 
behave  very  badly  at  times,  using  improper  language,  and 
manifesting  dissatisfaction  by  attacking  the  master  of  the 
house,  though  his  violence  never  extended  to  children  or  to 
the  hostess.  We  were  informed  that  he  rarely  broke  any 
thing,  never  tried  to  run  away,  and  never  molested  any  of  the 
servants.  No  means  of  restraint  were  resorted  to,  an  effort 
being  made  to  calm  his  excitement  by  kind  treatment.  In 
another  apartment  was  a  patient  whose  manners  and  appear- 
ance betokened  a  gentleman  of  culture.  In  his  room  was  a 
collection  of  books  which  evinced  fine  literary  taste.  This 
patient  was  said  to  be  a  Polish  prince,  and  this  was  his 
second  sojourn  here.  He  had  previously  left  Gheel  appar- 
ently cured,  but,  suffering  a  relapse,  he  returned  and  requested 
that  he  mieht  be  received  into  the  same  house. 


26o  THE   COLONY  OF  GHEEL. 

Leaving  apartments  which  were  exceptional  in  style  and 
completeness,  we  next  visited  an  abode  in  striking  contrast. 
Here  two  girls  and  a  boy  were  at  play  in  the  living-room 
or  kitchen,  the  floor  of  which  was  almost  level  with  the 
street.  An  older  boy  sat,  tailor  fashion,  on  a  table  sewing. 
One  woman  was  also  busy  plying  the  needle,  while  another 
was  engaged  at  housework.  There  were  two  female  patients 
here.  The  kitchen  floor  was  laid  with  brick,  and  it  was 
rather  dirty.  Some  of  the  house  furnishings  showed  signs  of 
comfort.  Climbing  a  very  steep  flight  of  stairs,  we  reached 
an  attic  chamber  of  large  size,  in  which  was  a  wooden  box- 
pattern  bedstead  that  had  two  straw  mattresses,  one  above 
the  other,  clean  linen,  and  two  pillows.  The  small  window 
had  hinged  sash,  and  was  protected  by  four  slender  wooden 
bars.  The  door  had  a  wooden  latch  and  an  outside 
bolt.  The  second  bedroom,  9  x  lo  feet,  contained,  like  the 
first,  a  good  bed,  and  the  floor,  like  that  of  the  larger  apart- 
ment, was  clean.  The  smaller  room  was  lighted  from  a  sin- 
gle pane  in  the  roof.  Here  were  signs  of  dampness,  and 
there  was  no  means  of  ventilation. 

In  a  narrow  alley  leading  from  the  main  street,  and  ter- 
minating in  a  garden  plot  cultivated  by  those  living  in  its 
vicinity,  we  came  upon  a  low  block  of  several  dwellings. 
Entering  one  of  these  by  the  street  door,  we  found  our- 
selves in  an  apartment  fulfilling  the  several  offices  of 
kitchen,  sitting-room,  and  dining-room  for  a  household 
consisting  of  a  husband,  wife,  seven  children,  and  two 
female  patients.  Here  the  head  of  the  household  was  sit- 
ting by  tlie  fire  with  a  child  on  his  knee — the  picture  of 
domestic  felicity.  The  husband  and  wife,  together  with  five 
of  the  children,  slept  in  a  room  scantily  lighted  from  a  win- 
dow opening  into  the  living-room  of  the  house.  This 
sleeping  apartment  was  in  a  state  of  confusion,  being  filled 


A   TROUBLESOME  PATIENT.  261 

with  furniture  and  clothing.  A  steep  flight  of  stairs  led 
from  this  back  room  to  the  attic,  where  the  two  insane 
women  and  the  two  eldest  children  slept.  The  patients 
occupied  respectively  the  front  and  back  portions  of  this 
attic,  while  the  children  slept  in  an  intermediate  open  space. 
In  the  adjoining  cottage  of  similar  internal  construction 
to  that  just  mentioned  resided  a  man  and  his  wife,  one 
child,  and  two  female  patients,  one  of  whom,  reputed  to  be 
idle  and  nervous,  was  in  the  habit  of  beating  the  mistress  of 
the  house.  It  was  said  that  the  next-door  neighbor  had 
sometimes  to  be  called  in  to  assist  in  restraining  her  when 
violent.  The  other  patient  was  also  indisposed  to  work. 
Here,  as  in  many  other  of  the  humble  abodes,  the  poverty 
of  the  mistress  denied  her  the  luxury  of  stockings.  Her 
wooden  shoes  caused  an  awkward  gait  and  made  a  clatter- 
ing sound  upon  the  floor  in  walking.  In  the  living-room, 
■or  kitchen,  colored  prints  of  saints  in  rude  frames  were 
hung  on  the  wall,  upon  which  were  also  a  crucifix,  and  a 
mirror  surrounded  by  photographs.  The  husband,  wife, 
and  child  slept  in  a  dark  bedroom  back  of  the  kitchen. 
The  floor  of  the  latter  was  sanded.  The  patients  slept 
up-stairs.  In  one  of  their  bedrooms  was  an  iron  bedstead, 
box-pattern,  with  temporary  foot-board.  The  bed  looked 
comfortable,  having  two  pillows,  clean  linen,  and  a 
straw  mattress,  underneath  which  was  a  tick  filled  with 
straw.  The  floor  was  bare,  and  the  furniture  comprised  one 
chair,  a  chest,  and  a  short  rack  for  clothes.  The  window  in 
the  roof  had  two  panes,  each  about  9X  16  inches.  There 
was  no  means  of  ventilation.  In  the  larger  front  attic  room 
there  was  a  French  wooden  bedstead  with  a  straw  bed,  a 
wool  mattress,  and  plenty  of  bed-clothing  which  was  pass- 
ably clean.  The  other  furniture  consisted  of  a  chest  and  a 
rack  for  clothes. 


262  THE   COLONY  OF  GHEEL. 

The  windows  of  the  next  house  had  clean  white  dimity 
curtains.  The  occupant,  a  widow,  stated  that  she  had  five 
children  away  from  home,  and  residing  with  her,  one  son,  an 
aged  father,  and  two  female  patients.  One  of  the  latter,  a 
middle-aged  woman,  was  sewing  in  the  front  room.  The 
other,  who  was  much  older,  and  deaf  and  dumb,  sat  idly  by 
the  fire.  She  had  been  here  for  a  great  many  years,  and  had 
helped  the  widow  to  rear  and  care  for  her  large  family. 
The  proprietress,  for  this  reason,  held  her  in  great  esteem. 
In  this  patient's  bedroom  we  were  shown  a  little  basket  in  a 
corner  containing  two  rosy-cheeked  dolls.  These,  it  was 
said,  received  much  of  the  patient's  attention,  being  even 
taken  to  bed  by  her  at  night.  We  were  also  shown  a 
box  of  toys  and  trifles  used  for  the  gratification  of  the 
imaginary  children.  The  widow  was  evidently  affected  in 
speaking  of  these  manifestations  of  a  motherly  instinct — 
apparently  the  only  unbroken  link  obscurely  connect- 
ing this  poor  creature  with  the  world  of  intelligence. 
On  the  mantel-shelf  of  the  day-room  was  the  customary 
crucifix,  and  on  the  wall  an  old  pendulum  clock. 
Over  the  door  leading  to  the  back  room  was  a  figure  of  the 
Virgin,  with  two  bright  silver  candlesticks,  one  on  either 
side.  In  the  attic,  two  rooms  were  partitioned  off  as  bed- 
rooms. Both  of  these  had  wooden  bedsteads,  clean  and 
comfortable  beds,  chairs,  and  clothes-racks.  Each  was  lighted 
by  a  large  pane  in  the  roof.  There  was  no  means  of  ven- 
tilation. One  of  the  chamber  doors  was  bolted.  Here,  as  else- 
where in  Gheel,  the  bolt  was  on  the  outside  of  the  door  of  the 
patient's  sleeping-room.  The  register-book  showed  that  the 
doctor  had  made  thirteen  visits  during  the  preceding  twelve 
months. 

Before  leaving  this  alley  we  noticed  at  its  extremity 
an   out-house  havin"-  a  number  of  stalls  without  doors.  It 


INSPECTIONS  IN    THE   COUNTRY.  263 

was  for  the  common  use  of  those  in  the  neighborhood.  It 
had  a  shallow  open  pit  underneath,  was  in  full  view  of  the 
passers-by,  and  gave  rise  to  gross  violations  of  propriety,  an 
instance  of  which  came  under  our  observation. 

Entering  another  cottage,  we  found  its  inmates  were  the 
woman  of  the  house,  her  grown-up  daughter,  and  two 
patients — one  an  adult  female,  the  other  an  idiot  child.  The 
elder  patient  had  gone  out  in  charge  of  the  grandchild  of 
the  mistress.  The  idiot  child  was  filthy  and  required  much 
attention.  The  house,  nevertheless,  looked  clean.  The 
grown-up  patient  was  boarded  for  219  francs  and  the  child 
for  313  francs  per  annum.  The  former  slept  in  a  small,  low- 
roofed  back  room,  having  a  small  grated  window.  The  bolt 
on  the  outside  of  the  door,  it  was  said,  was  never  used. 
Bars  and  bolts  were  here  spoken  of  as  relics  of  the  past. 

In  another  large  cottage  resided  a  widow  and  three 
grown-up  daughters.  The  occupants  were  all  tidily  dressed, 
the  house  was  neatly  kept,  and  the  furnishing  was  good. 
There  were  here  two  patients,  each  paying  316  francs  a 
year.  One  of  these,  an  old  woman,  said  to  be  of  uncleanly 
habits,  had  a  room  on  the  ground-floor. 

OUT     IN    THE     COUNTRY, 

The  houses  visited  up  to  this  point  were  in  the  town. 
Afterwards  an  examination  was  made  of  the  cottages  in  the 
thickly  settled  surrounding  parishes.  In  the  inspection  of 
this  part  of  the  colony  a  two-wheeled  vehicle  peculiar  to  this 
country,  having  seats  for  four  persons,  was  used.  The  roads 
in  some  portions  of  the  outskirts  were  found  to  be  even  worse 
than  those  in  the  prairie  regions  of  America,  being  in  wet 
seasons  very  muddy  and  almost  impassable.  Many  of  the 
houses  indicated  that  the  lives  of  the  occupants  were  little 
else  than  a  struggle  for  bare  subsistence.     The  fuel  used  in 


264  THE   COLONY  OF  GHEEL. 

the  daytime  for  cooking  was  mainly  brushwood.  In  the 
evening  peat  is  burned. 

The  first  farm  cottage  we  examined  was  a  one-story 
building  with  straw-thatched  roof.  In  one  end  resided 
the  family,  and  the  other  was  used  as  a  stable.  The  well 
was  but  a  few  feet  from  the  door  of  the  house,  and  about 
twenty  feet  from  the  stable.  The  patients  were  out,  and  the 
only  person  in  the  house  was  a  woman  who  was  working 
in  the  kitchen.  She  wore  no  stockings,  and  her  feet  were 
protected  only  by  wooden  shoes. 

Leaving  these  ill-conditioned  premises,  we  soon  came  to  a 
low  building  with  thatched  roof,  which,  like  the  former,  was 
rented.  Here,  also,  one  end  was  allotted  to  the  family,  and 
the  other  to  the  cattle.  Close  to  the  door  of  the  house  was 
the  manure  pile.  The  tile  floor  was  level  with  the  ground, 
and  damp.  The  well  was  only  ten  feet  from  the  house  and 
stable.  The  mistress  wore  a  dirty  dress,  clogs,  and  no 
stockings.  There  were  two  male  patients  in  the  kitchen,  or 
living-room.  One  was  idle,  the  other  was  peeling  potatoes 
near  the  fire-place.  This  was  ten  feet  broad,  three  feet  deep, 
and  there  was  a  baking-oven  on  one  side.  As  is  usual 
in  these  farm  cottages,  the  fire  was  made  on  the  hearth. 
From  a  high  wooden  crane  was  suspended  a  large  kettle 
used  for  boiling  food  for  cattle.  This  was  so  arranged  that 
the  kettle  and  its  contents  could  be  swung  round  to  a  door 
opening  from  the  kitchen  into  the  stable. 

Another  mode  in  Flemish  farm-houses  of  conveying 
cooked  food  to  stock  is  by  means  of  a  semi-circular  rail  near 
the  ceiling,  extending  from  the  kitchen  fire-place  to  the 
stable  door,  there  being  thus  direct  internal  communication 
between  the  culinary  and  cattle  departments,  though  at 
some  sacrifice  of  pure  air. 

The  next  farm  cottage  was  owned  by  its  occupant,  and 


PECULIAR    CUSTOMS.  265 

was  in  a  little  better  condition.  It,  too,  had  stable  commu- 
nication with  the  kitchen  fire-place  and  a  like  arrangement 
for  conveying  the  food  to  the  stable.  The  floor  was  little 
higher  than  the  ground  outside.  The  house  was  occupied 
by  a  man  and  his  wife,  six  children,  and  two  patients,  both 
of  whom  had  just  returned  from  field  work  on  account  of 
rain.  The  man  of  the  house  and  his  two  boarders  wore 
wooden  shoes  without  stockings.  The  bedrooms  were  at  op- 
posite corners  of  one  end  of  the  house.  The  beds  were  com- 
fortable, having  double  mattresses  and  plenty  of  bedclothes. 
The  tile  floors  were  sanded,  and  in  the  outer  wall  there  was 
a  small  aperture  for  the  escape  of  water  used  in  washing  the 
floor.  Between  the  sleeping-rooms  and  the  kitchen  was  the 
family  room,  in  which  there  was  a  bed.  On  a  line  stretched 
across  the  apartment  were  hung  clothes  to  dry.  The 
family  slept  in  the  attic.  In  the  kitchen  was  seen  the 
familiar  clock  against  the  wall,  also  a  baking-oven  opening 
into  the  large  fire-place.  The  fire,  made  of  brushwood,  was 
in  a  cresset.  Kettles  were  suspended  by  a  saw-bar,  so  that 
they  could  be  adjusted  at  convenience.  Attached  to  the 
trunk  of  an  old  tree  was  a  wooden  crane  used  for  raising  and 
lowering  the  buckets  in  the  well,  which  was  but  a  few  feet 
from  the  door.  The  stable,  which  was  under  the  same  roof 
with  the  dwelling-house,  contained  a  calf  and  a  goat. 

The  next  rented  cottage  visited  was  of  similar  construc- 
tion to  the  last.  The  family,  including  a  man,  his  wife, 
and  five  children,  were  at  dinner  in  the  principal  room  or 
kitchen.  They  were  seated  at  a  small  square  table  in  the 
centre  of  the  apartment.  The  first  part  of  the  meal  con- 
sisted of  a  thin  soup  or  porridge  of  celery  and  rice,  in  which 
pork  had  been  boiled.  A  plate  of  potatoes  and  boiled  pork 
followed  the  soup.  The  porridge  was  palatable  and  the 
bread  was  good.     Seated  at  a  low  side-table,  near  the  door^ 


266  THE   COLONY  OF  GHEEL. 

were  two  male  patients  eating  the  food  which  had  been 
served  to  them.  They  were  allowed  spoons  and  forks.  This 
side-table  was  half  covered  with  soiled  garments,  including 
trousers,  overalls,  old  stockings,  a  shawl,  jacket,  etc.  The 
patients  were  dressed  in  fustian,  and  wore  caps,  stockings, 
and  wooden  shoes.  One  worked  in  the  fields,  the  other  in 
the  house.  They  were  said  to  give  no  trouble,  and  were 
boarded  for  219  francs  each  per  annum.  A  door  opened 
from  the  room  in  which  the  family  were  eating  into  the 
stable  adjoining,  and,  as  usual  under  this  arrangement,  the 
close  proximity  of  the  latter  was  disagreeably  perceptible. 
The  bedrooms  were  somewhat  larger  than  usual,  one  measur- 
ing 7x12,  the  other  9  x  10  feet.  The  floors  were  of  tile,  and, 
in  conformity  with  general  custom,  a  hole  through  the  outer 
wall  permitted  the  escape  of  floor  rinsings.  The  windows 
were  small  and  had  hinged  sashes  secured  by  iron  bars.  By 
night  the  doors  were  said  to  be  strongly  bolted  on  the  out- 
side. Each  room  had  a  chair  and  a  clothes-rack.  The  bed- 
ding, though  plentiful,  was  only  moderately  clean.  There 
was  no  ventilation.  Close  to  the  house  was  a  large  heap  of 
stable  manure,  and,  at  a  distance  of  twelve  feet  from  it  was 
the  well.  All  the  family,  children  included,  wore  stockings 
and  wooden  shoes. 

The  rule  requiring  patients  to  take  their  meals  at  the 
same  table  with  the  Jiote  or  nour r icier  wdiS,  said  to  be  difficult 
to  enforce.  A  deviation  from  the  regulation,  as  noticed  at 
this  house,  met  the  strong  disapproval  of  the  inspector,  who 
made  note  of  it  in  his  official  journal. 

The  next  farm-house  examined  was,  in  point  of  order 
and  cleanliness,  an  improvement  on  those  that  have  been 
described.  Its  proprietor  worked  twenty-five  acres  of  land, 
one  half  of  which  he  rented.  One  fifth  was  in  pasture,  the 
rest  in  cultivated  fields.     His  stock  comprised  eight  cows, 


A    QUAINT  INTERIOR.  26/ 

two  calves,  and  three  pigs.  The  kitchen  or  main  room  was 
large.  The  beams  overhead  were  quaintly  carved.  There 
were  rows  of  metal  dishes  in  racks  above  the  fire-place,  and 
all  metal  articles  were  brightly  polished.  The  fire-place  did 
not  differ  from  those  already  described.  The  inmates  were 
a  man  and  his  wife,  seven  children,  and  one  male  patient, 
who  was  said  to  be  very  good,  and  who  was  received  at  2ig 
francs  a  year.  He  appeared  strong  and  healthy,  was  attired 
in  cloth  cap,  fustian  clothes,  and  stockings,  and  wore 
wooden  shoes.  He  did  little  work  beyond  peeling  potatoes, 
for  which  they  said  they  gave  him  at  times  a  little  money  to 
spend  on  Sunday.  In  the  sitting-room  there  were  pictures  on 
the  walls  and  canary-birds  singing  in  their  cages.  The  furni- 
ture included  a  high  antique  clock,  an  old-fashioned  dresser, 
and  a  large  wardrobe.  A  lamp  placed  in  a  small  one-paned 
window  in  the  wall,  between  the  sitting-room  and  the  stable, 
gave  light  to  both  places.  A  long  rail  and  pulley  overhead 
were  here  used,  instead  of  a  crane,  for  moving  the  large 
kettle  from  the  kitchen  fire  into  the  adjoining  stable.  The 
patient's  bedroom,  on  the  same  floor,  measuring  9x12  feet, 
had  a  comfortable  curtained  bed,  and  a  large  two-sash 
hinged  window  without  grating.  Underneath  the  window 
was  the  usual  outlet  for  water  used  in  cleaning  the  floor.  The 
door  was  without  bolts,  and  the  furnishings  included  a  chair 
and  clothes-rack.  The  mid-day  meal  was  preparing.  It  con- 
sisted of  soup  and  pork,  with  white  and  brown  bread.  In 
the  stable,  close  by  the  kitchen,  were  two  cows. 

Passing  on  to  another  cottage  also  occupied  by  its  owner, 
we  saw,  as  in  some  other  places  visited,  that  the  hedges 
were  well  kept,  and  that  in  front  of  the  house  there  was  a 
plentifully  stocked  kitchen  garden.  This  dwelling  was  larger 
than  some  of  those  previously  visited,  and  tolerably  clean- 
looking.     The  main  room,  or  kitchen,  had  a  low  roof.     There 


268  THE   COLONY  OF  GHEEL. 

was  a  large  fire-place  here  and  an  iron  rail  arrangenient  for 
conveying  food  from  the  kitchen  fire  to  the  stable,  in  which 
were  several  cows  and  a  goat.  In  the  outer  wall  of  the 
kitchen  there  was  an  aperture  for  letting  out  the  floor  rins- 
ings. In  a  separate  sitting-room  the  walls  showed  signs  of 
dampness,  being  discolored  to  the  extent  of  nearly  three 
feet  above  the  ground.  The  mistress  of  the  house  wore 
stockings  with  her  wooden  shoes.  The  only  patient,  an 
old  man,  was  seated  in  a  corner  by  the  fire-place.  He  had 
on  wooden  shoes,  but  no  stockings.  We  were  informed  that 
he  had  been  here  nearly  half  a  century.  His  sleeping-room 
measured  7x8  feet,  and  was  6|-  feet  high.  The  furniture 
consisted  of  a  wooden  bedstead  and  a  chair.  The  patient's 
clothes  were  hung  on  wooden  pegs.  The  bedding,  including 
a  straw  bed  and  an  upper  mattress,  appeared  clean  and 
comfortable.  The  floor  was  of  tile  and  sanded.  The  win- 
dow, measuring  20  x  30  inches,  had  one  sash  and  no  grating. 
There  was  no  bolt  on  the  door.  The  walls  were  tinted. 
The  register  kept  here  was  the  oldest  we  had  yet  seen,  show- 
ing systematic  medical  visitation  extending  back  to  the  year 
1825. 

Another  farm  dwelling  inspected  was  also  occupied  by  its 
proprietor.  The  kitchen  was  smaller  than  those  just  de- 
scribed. The  floor  was  only  a  few  inches  higher  than  the 
ground  outside.  The  door  of  the  living-room  opened  into 
the  stable.  On  the  walls  were  several  photographs,  pictures 
of  saints,  and  a  crucifix.  A  quaint  old  clock,  convenient 
clothes-presses,  and  a  lively  canary  were  among  the  other 
noticeable  objects  here.  The  beams  overhead  were  discol- 
ored with  smoke.  Two  female  patients  approached  as  we 
were  taking  notes.  They  were  plainly  dressed  and  wore 
wooden  shoes.  One  muttering  to  herself  entered  the  house 
and  walked  out  again.     Both  seemed  excited,  talking  loudly 


A    QUIET  HAMLET.  269 

and  violently  gesticulating.  In  the  corner  of  the  kitchen 
stood  the  manure-fork  and  a  broom.  A  side  room  was 
used  both  as  a  sitting  and  sleeping  room.  The  bed- 
rooms had  tile  floors,  windows  20  x  30  inches,  and  each  door 
had  two  bars  and  a  bolt  on  the  outside.  In  the  walls 
were  holes  for  the  escape  of  floor  rinsings.  The  beds  and 
bedding  were  comfortable.  The  house  was,  on  the  whole, 
passably  clean.  We  were  told  that  during  the  day  the  pa- 
tients talked  incessantly,  but  that  they  were  quiet  during  the 
night.  Neither  of  them  worked,  and  belonging  to  the  ordi- 
nary class  of  patients,  they  were  received  at  219  francs  each 
per  annum. 

Leaving  the  foregoing  farm  cottages,  which  are  situated 
far  out  in  the  country,  we  approached  d  small  hamlet,  where 
the  spectacle  of  a  vehicle  containing  two  unannounced 
strangers  in  the  company  of  a  garde  de  section,  appeared  to 
be  an  event  so  unusual  as  to  awaken  considerable  interest 
among  the  juvenile  portion  of  this  secluded  community. 
As  we  paused  to  survey  a  onc-and-a-half-story  brick  building 
before  entering  it,  a  wondering,  interested,  and  barefooted 
little  crowd  gathered  about  us  at  the  door.  It  consisted  of 
seven  little  girls  and  ten  little  boys.  At  a  more  respectful 
distance  stood  several  adults,  among  whom  was  a  harmless 
idiot. 

Entering  the  roomy  kitchen,  wc  found  ourselves  in  what 
served  the  double  purpose  of  beer-house  and  dwelling-house. 
The  fire-place  measured  about  fourteen  feet  across,  or  nearly 
the  whole  breadth  of  the  kitchen,  which  forms,  as  usual,  the 
principal  apartment  in  these  houses.  A  small  kitchen  grate 
was  in  one  corner  of  the  fire-place,  and  in  the  centre  of  it, 
a  cresset  for  a  large  kettle.  A  door  opened  from  this  room 
into  the  stable.  On  a  long  shelf  were  brass  candlesticks,  a 
small  crucifix,  and  a  row  of  crockery  plates,  which  were  kept 


270  THE   COLONY  OF  GHEEL. 

in  position  against  the  chimney  by  a  string.  A  carved  beam 
overhead,  with  joists  on  either  side  of  the  fire-place,  support- 
ed the  roof.  The  stable  emitted  a  strong  odor.  Only  six 
feet  from  the  house  was  the  family  well.  Under  the 
eaves'  spout  was  a  vat  for  rain-water.  A  patient  whom 
we  saw  walking  in  the  garden  paid  400  francs  per  annum 
for  his  board.  Ascending  a  very  steep  and  narrow  staircase 
terminating  at  a  trap-door,  we  reached  the  bedroom,  meas- 
uring 10  X  12  feet.  It  had  a  fair  sized  window  without 
grating,  a  bedstead  and  a  good  bed,  a  rack  and  shelf  for 
clothes,  and  one  chair.  There  was  neither  carpet  nor  rug  on 
the  floor. 

Before  reaching  another  cottage  we  passed  on  our  way 
several  small,  poor-looking  houses,  three  sides  of  which  were 
constructed  of  loam  and  stubble,  and  one  side  of  brick.  The 
inspector  stated  that  the  patients'  sleeping-rooms  were  on 
the  brick-built  side.  Up  to  this  point  we  had  occasionally 
seen  patients  at  work  with  their  guardians  in  the  fields.  The 
implements  of  husbandry  seemed  rude  and  primitive. 

The  next  farm  cottage  visited  was  of  one  story,  and  the 
tenant  rented  along  with  it  nearly  nine  English  acres  of  land. 
It  had  a  low  thatched  roof,  brick  walls,  and  was  altogether 
very  ancient-looking.  A  patient  who  did  no  work  was 
standing  outside.  He  wore  woollen  stockings  and  wooden 
clogs.  The  manure  heap  was  only  twenty  feet  from  the 
kitchen  door.  The  floor  of  the  kitchen  was  but  very  little 
higher  than  the  ground  outside.  This  apartment  had 
a  large  black  fire-place,  the  smoke  from  which,  after  making 
futile  efforts  to  escape,  filled  the  room.  The  sooty  rafters 
underlying  the  thatched  roof  showed  overhead.  By  the 
fireside  sat  an  excited  and  talkative  female  patient  of  ad- 
vanced years.  The  chairs,  repaired  with  straw  and  rope,  were 
one  of  many  indications  of  pinched  living.     Altogether,  the 


A    LANDED   PROPRIETOR.  2/1 

condition  was  lower  than  in  any  of  the  cottages  hitherto 
visited.  The  inmates  were  a  man  and  his  wife,  six  children, 
and  two  patients.  It  being  an  afternoon  when  there  was 
no  school,  three  girls  were  at  home.  They  were  all  bare- 
footed. One  of  the  bedrooms  measured  7x10  feet,  and  had 
a  small  barred  window.  The  bed  was  not  so  good  as  the  one 
we  had  last  seen,  nor  could  it  be  commended  for  cleanliness. 
It  was  2  P.M.,  and  the  patient  had  just  risen.  The  second  bed- 
room was  much  the  same  in  appearance,  but  rather  cleaner. 
In  the  next  cottage  dwelt  its  proprietor,  who  cultivated 
thirty-two  acres  of  his  own  land.  The  kitchen  garden 
was  large.  In  the  stable,  which  connected  with  the  house 
and  formed  a  part  of  it,  were  cows  and  calves,  a  yoke  of 
working  oxen,  and  several  pigs.  About  forty  feet  equi- 
distant from  the  dwelling  and  the  well  was  a  closet  without  a 
door,  and  two  thatched  and  ruinous-looking  structures  used 
as  a  shelter  for  some  portion  of  the  farm  stock,  of  which 
there  was  more  than  was  usually  seen  on  these  small  hold- 
ings. A  vat  of  dirty  water  stood  about  ten  feet  from  the 
house,  and  only  eight  feet  from  the  well  which  was  about  the 
same  distance  from  the  door  of  the  dwelling.  The  well- 
water  presented  a  green  and  impure  appearance.  Over  the 
well  was  a  wooden  pole  fastened  to  the  trunk  of  a  tree  and 
used  for  raising  and  lowering  the  buckets.  The  tile  floor 
of  the  cottage  was  lower  than  the  ground  outside,  the 
entrance  was  dirty,  and  the  interior  wet  with  slops.  The 
door  between  the  kitchen  and  the  stable  was  wide  open, 
and  the  low  beams  overhead  in  the  kitchen  were  black  with 
smoke.  On  the  table  were  the  remnants  of  the  previous 
meal,  a  quantity  of  salt,  and  a  broken  and  dirty  old  comb. 
There  were  also  in  the  room  two  chairs,  a  bench  without  a 
back,  and  some  dirty  plates  and  cooking  utensils  scattered 
about.     The  appearance  of  all  the  inmates  indicated  great 


2/2  THE   COLONY  OF  GHEEL. 

personal  neglect.  The  husband,  wife,  and  two  patients 
wore  wooden  shoes  and  dirty  stockings,  and  the  daughter 
was  barefooted.  The  sleeping-rooms  were  up-stairs.  One 
had  a  small  grated  window,  and  the  box-bedstead  had 
unbarked  sticks  across  the  bottom.  The  bed,  insufificiently 
supplied  with  clothing,  had  not  been  made  up,  and  was  partly 
wet.  The  other  room  seemed  a  little  less  uncomfortable  ; 
but  the  bedstead  was  smaller,  the  floor  bare,  and  an  old 
broken  chair  without  a  seat  was  the  only  additional  furniture. 
Its  small  window  was  protected  by  two  bars.  Access  to 
these  rooms  was  through  an  attic  filled  with  rags,  old 
furniture,  and  miscellaneous  articles  lying  about  in  indescrib- 
able confusion.  Our  hostess  good-naturedly  conducted  us 
through  her  establishment,  seemingly  well  satisfied  with 
her  management  and  flattered  by  our  visit.  One  of  the 
patients  was  described  as  a  hard  worker ;  the  only  work  the 
other  did  was  to  peel  potatoes.  These  wretched  quarters 
showed  a  scene  of  uncleanness,  disorder,  and  discomfort, 
within  as  well  as  without,  which  left  a  most  unfavorable 
impression  upon  the  mind.  "  This,"  said  our  honest  guide, 
"  is  the  dirtiest  place  in  the  colony." 

The  last  of  the  farm  dwellings  visited  was  occupied  by 
its  proprietor,  and  it  had  attached  to  it  seven  and  a  half 
acres  of  land.  The  thin  walls  of  this  cottage  were  of  loam 
and  stubble,  and  the  roof  was  thatched.  At  one  end  was 
the  stable,  at  the  other  the  family  abode.  The  floor  was 
but  four  inches  above  the  level  of  the  ground  outside,  and 
in  the  wall  were  visible  fractures.  In  the  small  apartment, 
which  served  as  kitchen  and  living-room,  the  floor  was  of 
tile,  the  ceiling  low  and  black,  and  the  scanty  furniture 
included  a  rickety  table.  The  housewife  wore  wooden 
shoes,  and  she  was  begrimed  with  dirt.  Here  were  four 
children,  and  one   epileptic    patient  who  did  no  work  and 


SPECIAL  PRIVILEGES.  273 

seemed  disturbed  by  our  visit.  The  patient's  bedroom,  10 
X  12  feet,  had  a  small  window  and  tile  floor.  There  were 
two  bars  and  a  bolt  on  the  outside  of  the  door.  It  was 
entered  through  another  sleeping-room,  from  which  it  had 
been  partitioned  off.  This  had  an  earth  floor.  There 
were  but  few  of  the  necessaries  and  an  almost  entire  lack  of 
the  comforts  and  conveniences  of  life. 

CLOSE    OF    INSPECTION. 

My  third  day  at  Gheel  was  now  drawing  to  a  close,  and 
from  the  number  of  houses  visited,  and  the  widely  dif- 
ferent circumstances  in  which  I  found  the  insane,  the 
conclusion  was  reached  that  I  had  seen  enough  to  form  a 
correct  opinion  as  to  the  care  and  treatment  bestowed  upon 
them  throughout  the  colony. 

As  bearing  on  the  general  welfare  of  the  insane  in  family 
care,  it  may  be  further  stated,  that  those  boarded  with 
hole  or  noiirricicr  may  be  assigned  work  suitable  to  their 
capacity  or  inclination.  This  permission  the  authorities 
withdraw  if  they  find  that  a  patient  has  been  overworked. 
Such  matters  come  under  the  cognizance  of  the  gardes  des 
sections,  whose  visits  are  made  at  unexpected  times.  As  an 
inducement  to  work,  money  rewards  are  sometimes  given, 
and  we  were  also  informed  that  tractable  and  docile  patients 
have  extended  to  them  desirable  privileges,  such  as  attend- 
ing church,  fairs,  or  festivals  in  company  with  the  family. 

Neither  Jiote  nor  noiirricier  is  allowed  to  use  mechanical 
appliances  for  restraint  without  the  sanction  of  the  sectional 
physician.  As  accounting  for  the  presence  of  bolts  and 
bars  in  so  many  of  the  houses,  it  should  be  stated  that  the 
care-takers  are  by  law  held  responsible  for  any  damage 
a  patient  may  do,  and  for  his  capture  in  the  event  of 
escape.   It  is  claimed  that  there  are  few  acts  of  violence  and 


274  THE   COLONY  OF  GHEEL. 

that  suicides  are  extremely  rare.  A  tragic  story  is  told  of  a 
burgomaster  of  the  town  who  many  years  ago  met  his  death 
at  the  hands  of  a  patient.  The  number  of  escapes  during  the 
year  preceding  my  visit  was  given  as  twelve,  a  total  which 
had  not  been  exceeded  duringany  one  of  many  previous  years. 
In  these  cases  the  runaways  were  captured  and  returned,  as 
might  be  expected  in  a  community  where  the  householders 
act  in  such  emergencies  as  a  body  of  police,  and  render  one 
another  assistance. 

THE    COLONY  ;    ITS    ADVANTAGES    AND    DISADVANTAGES. 

The  advantages  of  the  Gheel  system  are  so  generally  un- 
derstood, that  it  is  unnecessary  to  detail  them  here  at  any 
length.  The  natural  conditions  of  home  life  where  the 
patient  is  made  one  of  the  family  circle  participating  in  its 
religious  privileges  and  social  enjoyments,  the  occupation  of 
mind  in  farm  pursuits  as  well  as  indoor  industries,  the  pecu- 
niary recognition  of  labor,  and  the  general  freedom  from 
restraint,  may  be  enumerated  as  among  the  incalculable  and 
unquestionable  benefits  of  the  colony.  On  the  other  hand, 
there  are  some  serious  defects,  which  cannot  in  any  just 
estimate  be  lightly  passed  over.  These  are  not  so  manifest 
on  the  surface,  for  the  simple  reason  that  there  is  a  common 
interest  to  keep  in  the  background  evils  which  are  inherent 
in  the  system  and  beyond  the  control  of  individual  effort. 

In  considering  the  Gheel  colony  as  a  whole,  the  fact  must 
never  be  lost  sight  of,  that  the  insane  admitted  into  the 
commune  are  a  selected  class  and  are  boarded  out  under 
what  may  be  termed  a  double  recommendation  or  certifi- 
cate. In  the  first  place,  the  committing  authorities  regard 
them  as  suitable  cases  for  family  care,  and,  again,  their  fit- 
ness is,  as  it  were,  confirmed,  on  their  passage  through  the 
observation  station.     Yet,  as  has  been  shown,  many  even  of 


ADVANTAGES  AND  DISADVANTAGES.  275 

this  selected  class  are  necessarily  returned,  no  less  than  ten 
per  cent  of  each  year's  arrivals  at  the  central  station  being 
rejected  as  unsuitable.  The  Gheel  colony,  therefore,  does 
not  present  a  comprehensive  system  adapted  to  all  classes  of 
the  insane.  It  was  further  authoritatively  stated  that  there 
were  at  Gheel  few  curable  patients,  most  of  them  having 
undergone  treatment  before  reaching  the  colony. 

The  salaries  of  the  sectional  physicians  are  small  and  their 
districts  large.  The  sixteen  hundred  patients  of  the  colony 
must  be  visited  once  a  month  and  acute  cases  as  often  as 
their  exigencies  require.  As  this  work  is  in  addition  to  a 
private  practice  of  the  sectional  physicians,  its  satisfactory 
performance  must  be  difficult.  In  the  inspection  of  the 
cottages,  the  register-books  were  examined,  and  it  was 
found  that,  although  there  was  the  requisite  number  of 
medical  visits,  averaging  one  a  month  during  the  year, 
there  were  occasionally  long  intervals  between  visits.  In 
one  instance  there  was  no  entry  made  for  ten  weeks. 

The  number  and  proximity  of  places  where  intoxicating 
drinks  are  sold  indicated  a  danger,  though  it  must  be  ad- 
mitted that  no  case  of  actual  excess  came  under  my  obser- 
vation. The  law  forbids,  under  penalty  of  fine  or  imprison- 
ment, the  sale  of  brandy  or  other  spirits  to  the  insane,  yet 
these  liquors  are  generally  kept  for  sale  in  the  public  houses. 
Wines  are  too  costly  to  come  within  the  reach  of  any  large 
number  of  the  patients.  But  the  only  restriction  on  the 
sale  of  beer  is  that  the  insane  must  not  be  allowed  to  drink 
"  too  much."  This  may  be  a  knotty  point  to  determine  when 
the  definition  is  left  to  the  beer-seller,  who  must  make  out 
of  his  business  the  maximum  of  profit  consistent  with  the 
bare  observance  of  rules. 

The  care  of  the  insane  is  relied  upon  by  the  people  of  the 
place  as  their  main  business  or  means  of  money-maki-ng.     It 


2/6  THE   COLONY  OF  GHEEL. 

is  therefore  liable  to  abuses  common  to  all  undertakings 
that  are  governed  by  considerations  of  profit  and  loss. 
Yet  it  may  be  urged  that  it  is  the  interest  of  every  trader  to 
maintain  a  good  reputation,  and  to  avoid  acts  of  cruelty  or 
neglect,  which  would  not  only  injure  his  own  business,  but 
damage  that  of  the  entire  colony.  In  this  way  an  esprit  de 
corps  is  established,  which,  no  doubt,  tends  to  prevent  abuses 
of  a  flagrant  character.  There  are,  however,  faults  for  which 
the  care-takers  cannot  justly  be  held  responsible.  Prices  are 
made  so  low  by  the  authorities  that  it  is  found  impracticable 
to  meet,  in  all  respects,  the  standard  regulations.  For  ex- 
ample, there  is  a  rule  which  requires  that  patients  shall  be 
supplied  with  fresh  meat  every  day  ;  but  keepers  find  it 
difficult  to  observe  this  requirement.  Nevertheless,  it 
seemed  on  the  whole  that  the  pauper  insane  fared  as 
well,  if  not  better,  than  their  guardians.  The  advance  made 
since  my  visit  in  the  prices  paid  for  board  of  this  class 
it  is  hoped  has  enabled  the  nourriciers  to  improve  their 
dietary. 

Humble  as  are  the  accommodations  of  the  insane  at  Gheel, 
it  is  fair  to  presume  that  they  are  equal,  in  most  cases,  to 
those  of  the  homes  whence  they  came.  Generally,  the 
treatment  of  the  patients  in  the  several  houses  appeared  to 
be  considerate,  and  marked  by  a  degree  of  proficiency  indi- 
cating an  instinctive  and  possibly  hereditary  tact  in  dealing 
with  them,  though  among  the  iwiirricicrs  were  some  mani- 
festly lacking  in  qualifications  which  would  be  deemed  essen- 
tial in  an  asylum  attendant. 

Considering  the  large  extent  of  territory  and  the  number 
of  the  insane,  it  is  hardly  possible  that  the  supervision  can  be 
so  complete  as  to  insure  the  due  observance  of  the  rules  and 
regulations  established  by  the  government  for  their  protec- 
tion.    The  straining  after  economy,  which  regulates  the  rate 


ADVANTAGES  AND  DISADVANTAGES.  2// 

of  maintenance,  as  has  been  shown,  affects  the  quality  of  the 
food,  and  also  influences,  prejudicially,  the  nature  of  the 
medical  and  other  supervision. 

There  appeared  to  be  a  lack  of  intelligent  provision  for 
the  needs  of  the  patients  in  regard  to  bathing  facilities, 
ventilation,  pure  water,  and  other  requisites.  The  damp 
floors,  the  primitive  methods  of  getting  rid  of  floor  rinsings, 
and  the  too  frequent  proximity  of  stables  and  manure  heaps 
to  the  farm  cottages,  show  a  lamentable  indifference  to  sani- 
tary considerations. 

Incidental  to  the  system  is  the  opportunity  for  exercising 
the  tendency,  natural  in  children  and  young  persons,  to  trifle 
with  the  insane  and  idiotic.  Chafing  was  not  observed  to 
such  an  extent  as  to  produce  any  great  amount  of  irritation 
in  the  patients,  yet  it  was  sufificiently  manifested  in  the 
streets  to  convince  me  that  the  practice  was  one  which 
might  lead  to  injurious  results. 

In  proportion  to  population  the  number  of  idiots  belong- 
ing to  Gheel  who  were  not  boarders  appeared  to  be  abnor- 
mally large.  No  statistics  bearing  on  this  subject  were 
obtained,  but  it  would  be  interesting  to  know  whether  this 
seeming  disproportion  is  in  any  way  attributable  to  the 
presence  of  the  insane  in  such  large  numbers  among  the 
general  population.  This  question  assumes  some  import- 
ance when  we  bear  in  mind  the  opinions  which  have  been 
expressed  upon  it  by  medical  men.  No  less  an  authority 
than  Esquirol  has  made  the  following  forcible  observation  : 
"  To  the  inmates  of  a  madman's  family  the  sight  of  those 
acts  which  are  committed  by  the  insane  may  be  highly  prej- 
udicial. A  woman  who  is  enceinte  and  easily  excited  would 
run  some  risk  by  living  constantly  with  a  person  who  is 
mentally  deranged,  and  the  example  to  children  and 
young  ladies  might  become  a  predisposing  cause  of  men- 
tal disease." 


278  THE   COLONY  OF  GHEEL. 

Looking  at  the  commune  in  its  moral  aspect,  one  cannot 
help  thinking  that  the  shockingly  immodest  exhibitions 
which  here  and  there  meet  the  eye  must  have  a  baneful 
influence  on  the  large  number  of  children  of  both  sexes 
growing  up  in  their  midst.  Nor  can  one  approve  of  the 
presence  of  some  insane  young  women  in  the  colony,  who^ 
from  their  erotic  natures,  seemed  helplessly  exposed  under 
the  circumstances  in  which  they  were  placed.  That  liberty, 
so  beneiicial  to  many  of  the  mentally  afflicted,  was,  in  their 
case  at  least,  unwisely  bestowed.  It  appears  that  illegiti- 
mate births  do  sometimes  occur  here  among  the  insane. 
One  authority  estimated  these  as  happening  not  oftener 
than  once  in  five  years  ;  another  maintained  that  they  were 
more  frequent.  Any  system,  under  which  such  occurrences 
are  at  all  possible,  is  greatly  at  fault. 

Gheel  has  been  dealt  with  at  some  length  because  of  its 
many  points  of  interest,  and  for  the  additional  reason  that 
its  boarding-out  system  has  presented  itself  in  quite  different 
aspects  to  those  who  have  studied  its  workings.  After  a 
careful  examination  of  the  colony,  the  writer  is  forced  to 
the  conclusion  that  the  Gheel  system  is  of  little  practical 
value  to  America,  except  as  demonstrating  that  a  great 
amount  of  freedom  is  possible  in  the  care  of  certain  classes 
of  the  insane. 


CHAPTER  VII. 

THE    PROVINCIAL    INSANE    ASYLUM    OF    ALT- 
SCHERBITZ. 

OF  the  many  asylums  for  the  insane  in  Europe,  there  is 
none  more  interesting  than  that  of  Alt-Scherbitz, 
one  of  the  two  pubHc  institutions  that  meet  the  require- 
ments of  the  Province  of  Saxony  in  Prussia.  Here  has 
been  wrought  out  a  system  in  which  are  incorporated  some 
of  the  best  and  most  modern  methods  of  caring  for  the 
insane  in  England,  Scotland,  France,  and  other  countries. 

This  asylum  is  situated  in  a  fertile  valley  about  a  mile 
and  a  half  from  Schkeuditz,  which  is  its  station  on  the 
railway  line  from  Halle  to  Leipzig.  The  central  buildings, 
which  comprise  the  administration  department,  reception 
stations,  observation  stations,  detention  houses,  hospital  for 
the  bodily  sick,  etc.,  are  entirely  separate  from  one  another, 
having  no  corridor  connection,  and  are  situated  in  the  midst 
of  improved  grounds  lying  on  the  left  of  the  highway  lead- 
ing to  Leipzig.  These  are  unpretentious  brick  structures, 
with  outer  porches.  On  the  right  of  the  highway  are  the 
domestic  and  industrial  departments,  the  superintendent's 
residence  (formerly  the  Manor  House),  and  scattered  cot- 
tages for  patients.  Near  by  is  the  small  hamlet  of  Alt- 
Scherbitz,  lying  within  the  asylum  estate,  which  contains 
upwards  of  seven  hundred  English  acres.  This  property 
cost  the  round  sum  of  one  million  marks  (about  $240,000). 
Ten  of  the  cottages  in  the  hamlet  are  owned  by  the  asylum, 

279 


280  ALT-SCHERBITZ. 

and  are  occupied  by  quiet  patients.  Others  are  used  as 
residences  for  the  workmen  connected  with  the  institution. 
Through  the  estate  flows  the  river  Elster,  a  small  stream 
with  picturesque  borders.  On  its  right  bank  and  about  the 
superintendent's  residence  and  the  cottages  are  ornamental 
grounds.  On  one  of  the  terraces  here  is  a  plain  monu- 
ment, erected,  as  its  inscription  shows,  by  the  people  of  the 
Province  of  Saxony,  in  memory  of  the  humane  and  in- 
telligent founder  of  the  asylum,  Professor  John  Maurice 
Koeppe.  The  object  of  the  institution,  originally  planned 
for  450  patients,  but  subsequently  enlarged  so  as  to  accom- 
modate 600,  is  "  the  recovery  of  the  apparently  curable,  also 
the  reception  and  care  of  the  incurable  and  dangerous  in- 
sane of  the  province." 

Formerly  all  the  Prussian  asylums  for  the  insane  were 
under  state  control.  Since  the  direction  of  local  affairs 
has  been  intrusted  to  the  provinces,  they  have  managed 
their  own  institutions  for  the  insane,  deaf  and  dumb,  and 
blind.  The  state,  however,  still  retains  its  right  of  super- 
vision over  these  institutions.  The  chief  ofificer  of  the 
provincial  government  is  the  "Landes  Director,"  who,  with 
several  councillors  (Landes  Rathen),  directs  the  current 
affairs  of  the  provincial  government.  For  the  disposal 
of  matters  beyond  the  jurisdiction  of  the  "  Landes  Di- 
rector "  there  is  a  so-called  Provincial  Committee,  which 
meets  about  every  two  months,  or  as  necessity  demands. 
It  consists  of  fourteen  members  of  the  Provincial  As- 
sembly. The  latter  body  is  composed  of  over  one  hundred 
delegates  from  all  parts  of  the  province,  who  convene 
once  in  two  years  to  consider  and  transact  the  business 
of  the  province.  With  it  rests  the  chief  control  of  the  in- 
stitution and  the  appointment  of  the  medical  director  or 
superintendent  of  the  asylum.     Reports  of  the  medical  work 


EXPLANATION. 

Central  Institution  <     »  K,t,pt,„„  sm,o„.    a  D,t,ntim  h 

Kitchen  ^  '  ^•^•'°'-  /  >''"t^r,. 

Kitchen  dwellings 

Laundry  dwellings 

Laundry 

Dairy  with  dwellings 

Horse  stable  and  dwellings 

The  Director  s  Residence 

Far7n-buildings 

Assejnbly -house 

Brickmaking  establishment 

Village  houses,  formerly  belonging  to  villagers 

Men' s  Villas 

Wotnen' s   Villas 

Bath-houses 

Pavilions  for  infirm  chronic  cases 

Residence  of  one  of  the  Assistant  Physicians 


^     -D 


GENERAL     PLAN 

OF     THE 

PROVINCIAL     INSANE     ASYLUM, 

ALT  =  SCH  ERBIXZ. 

Institution    Buildings, 
Farm   Buildings  etc. 


^^    i-      A      D      ij       \V     s 


A  DM  IN  IS  TRA  TION — A  DMISSION.  2  8 1 

and  of  the  administration  are  made  to  the  chief  of  the  pro- 
vincial government,  the  "  Landes  Director,"  who  resides  at 
Merseburg  ;  Hkewise  statistical  reports  of  the  entire  result 
of  the  management  to  the  statistical  central  bureau  at 
Berlin.  Under  the  supervision  and  inspection  of  the  Pro- 
vincial Committee  and  the  "  Landes  Director"  the  affairs  of 
the  asylum  are  administered  by  its  Superintendent,  Dr. 
Paetz,  who  is  appointed  for  life  with  the  same  right  to  a 
pension  as  other  officers  holding  life  appointments.  He  is 
assisted  by  a  second,  third,  fourth,  and  fifth  physician  ;  also 
by  an  accountant,  a  secretary,  an  assistant  secretary,  a 
steward,  a  house  overseer,  and  a  land  overseer.  His  juris- 
diction covers  all  the  medical  and  economical  affairs  of  the 
asylum  and  grounds  or  land.  As  the  chief  officer,  he  ad- 
ministers to  subordinates  the  oath  of  office,  and  preserves 
order  and  discipline  according  to  rules.  He  may  be  absent 
from  the  institution  for  three  days  without  permission,  if  he 
arranges  to  have  his  place  properly  filled  ad  interim;  and 
he  may  grant  to  any  of  his  subordinates  eight  days'  leave  of 
absence. 

The  asylum  must  receive  all  curable  patients,  and  of  the 
incurable  those  who,  at  the  same  time,  are  dangerous  or 
burdensome  to  their  families  or  the  public.  Incurable  pa- 
tients not  dangerous  have  also  been  admitted,  and  will 
be  while  the  province  has  sufficient  room  in  its  asylums. 
Refusal  to  receive  patients  scarcely  ever  occurs. 

Applications  for  admission,  to  which  a  certificate  from  the 
district  physician  is  attached,  are  sent  from  the  authorities 
where  the  patient  resides  to  the  asylum  superintendent. 
The  latter  has  the  right  in  all  urgent  cases,  also  in  all  cases  of 
curable  or  dangerous  patients,  to  admit  without  delay.  He 
communicates  the  proper  intelligence  to  the  local  authori- 
ties and  to  the  friends  or  relatives  of  the  patient,  and  makes 


282  ALT-SCHERBITZ. 

a  short  report  thereon  to  the  "  Landes  Director,"  which 
accompanies  the  application  for  admission.  In  cases  not 
pressing,  the  asylum  superintendent  transmits  the  applica- 
tion for  admission  received  by  him  to  the  "  Landes  Director," 
with  a  short  discretionary  opinion  on  what  grounds  the 
application  was  accepted  or  rejected,  and,  according  to  this 
submitted  opinion,  then  the  "  Landes  Director  "  will  report 
to  the  local  authorities  who  made  application  for  the  patient. 

The  insane  are  conveyed  to  the  asylum  with  accompanying 
documents  setting  forth,  among  other  things,  whether  the 
friends  legally  responsible  are  willing  and  able  to  bear  the 
cost  of  the  needed  care  in  whole  or  in  part,  or  whether  this 
is  to  be  defrayed  out  of  means  belonging  to  the  patient. 
When  there  are  particulars  which,  in  the  interest  of  the 
patient,  his  relatives,  or  friends,  should  be  kept  secret,  but 
which  are  necessary  to  a  perfect  understanding  of  the  case 
by  the  physicians,  such  particulars  are  excluded  from  the 
admission  papers,  and  are  sent  separate,  in  a  sealed  envelope, 
to  the  superintendent  of  the  asylum.  The  rules  forbid  the 
reception  of  an  insane  person  who  has  been  exposed  to  con- 
tagious or  infectious  diseases  until  six  full  weeks  have 
elapsed  after  exposure.  Upon  the  approval  of  the  superin- 
tendent and  under  his  regulations,  patients  are  allowed  to 
have  special  attendants. 

After  making  arrangements  with  friends  of  the  patient  or 
others  for  his  support,  the  superintendent,  acting  independ- 
ently, makes  absolute  discharge.  When  dangerous  pa- 
tients, committed  directly  by  the  local  authorities,  have 
recovered,  the  latter  are  informed.  Discharge  on  trial  is 
allowed,  and  in  all  such  cases  the  relatives,  or  authorities  to 
which  the  insane  are  chargeable,  undertake  supervision,  and 
every  three  months  communicate  with  the  asylum  superin- 
tendent  respecting   the   health   of    the    patient.      All    such 


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CENTRAL  INSTITUTION.  283 

reports  are  signed,  not  only  by  the  relative  or  guardian,  but 
by  a  medical  authority.  After  two  favorable  reports,  the 
name  of  the  patient  is  struck  off  the  books  of  the  asylum. 

The  institution  was  opened  in  1876,  when  forty  insane 
persons  were  conveyed  to  the  old  farm-house  of  the  Alt- 
Scherbitz  manor.  At  the  same  time  the  central  institu- 
tion buildings  were  begun. 

Patients  of  what  is  termed  the  "  first  class  "  were  admitted 
at  a  yearly  payment  of  1,200  marks  ($288)  ;  patients  of  the 
"  second  class  "  at  600  marks  ($144)  ;  and  patients  of  the 
"third  class"  at  240  marks  ($57.60),  for  which  sum  the 
last  named  are  provided  with  clothing  in  addition  to  main- 
tenance. Any  difference  between  the  payment  and  the 
actual  cost  is  defrayed  by  the  provincial  government.  An 
additional  charge  is  made  for  patients  received  from  other 
provinces. 

The  two  reception  stations  of  the  central  institution — one 
for  men  and  one  for  women — are  clinical  passage  ways  for 
all  newly  received  patients,  who  are  detained  here  as  long 
as  they  need  continual  care  and  treatment.  Those  who 
remain  in  these  stations  are  usually  the  acute  curable  cases, 
the  incurable  ones  being  soon  transferred  to  other  depart- 
ments. 

The  observation  stations — one  for  each  sex — are  for  pa- 
tients who,  though  not  of  the  acute  class,  need  special  obser- 
vation because  they  are  not  sufificiently  capable  of  self-control 
nor  reliable  enough  for  reception  in  the  colonial  stations. 

The  two  detention  houses  are  for  such  male  and  female 
patients  as  it  is  necessary  to  restrict  because  of  their  being 
restless  or  dangerous,  or  from  the  suspicion  of  their  having 
a  desire  to  escape. 

Centrally  situated  in  the  front  of  the  group  constituting 
the  central  institution  is   the  administration    building,  the 


284  ALT-SCHERBITZ. 

houses  occupied  by  women  being  on  the  right  side  and 
those  by  men  on  the  left.  Rearward  from  this  is  placed  the 
hospital  for  the  bodily  sick,  having  a  department  for  each 
sex.  Near  the  latter  and  completely  hidden  by  trees  is  the 
mortuary. 

The  low  brick  walls  which  inclose  the  yards  at  the  rear 
of  the  detention  houses  have  sunken  panels,  and  are  sur- 
mounted at  intervals  by  pillars  supporting  an  architrave. 
They  are  architecturally  designed  to  conceal  their  purpose, 
and  are  screened  by  shrubbery  and  creeping  vines  that 
twine  gracefully  about  the  pillars.  Except  in  the  isolation 
rooms,  the  windows  of  all  the  buildings  belonging  to  the 
central  asylum  group  have  neither  bars  nor  gratings. 

On  the  first  floor  of  the  administration  building  is  a 
reception  room,  a  conference  room,  the  superintendent's 
office,  an  accountant's  office,  a  treasurer's  office,  and  a 
porter's  rooms.  On  the  second  floor  are  the  living  and 
other  apartments  of  the  second  physician  and  those  of  the 
accountant. 

The  reception  stations,  built  to  accommodate  fifteen 
patients  each,  are  plain  but  comfortable  buildings,  and  with- 
in and  without  resemble  private  dwellings.  They  have 
unlocked  doors,  and  there  is  no  suggestion  of  irksome 
restraint.  In  the  building  for  women  resides  the  head 
female  attendant ;  and  in  that  for  men,  one  of  the  assistant 
physicians. 

In  the  observation  stations,  each  of  which  is  intended  to 
accommodate  thirty-five  patients,  the  furnishing  was  ample 
and  comfortable.  Here,  as  in  some  other  departments, 
provision  is  made  for  open  fires.  The  windows  were,  with 
one  exception,  unlocked,  the  exception  being  one  with  a 
lockable  sash  in  a  room  that  was  less  under  the  attendant's 
eye  than   the  others.     Windows  of  rooms   that  are  opposite 


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CENTRAL    INSTITUTION.  285 

and  are  occupied  respectively  by  men  and  women,  have 
frosted  panes.  The  doors  open  rearward  to  shrubbery- 
planted  plots,  and  in  front  to  wide  porches  and  the  open 
grounds.  Fine  views,  immediate  and  distant,  are  had  from 
both  windows  and  porches.  In  one  of  the  rooms  on  the 
women's  side  there  were  two  curtained  couches  for  the 
use  of  such  patients  as  desired  occasional  rest.  In  the 
windows  and  in  other  parts  of  the  rooms  were  bright  flowers. 
There  is  also  an  abundance  of  health-giving  light.  The  sit- 
ting-rooms had  plain  chairs  and  sofas.  Each  station  has 
separate  sitting  and  dining  rooms.  Six  single  rooms  are 
set  apart  for  patients  of  a  higher  class.  The  sleeping  apart- 
ments in  the  observation  stations  are  mostly  on  the  associ- 
ate plan  and  were  provided  with  iron  bedsteads,  each  having 
a  temporary  foot-board,  mattress  of  straw,  India  fibre,  or 
horse-hair,  over  which  was  placed  a  second  mattress,  blanket, 
blanket  cover,  bolster,  and  pillow.  The  oiled  wooden  floors 
were  uncarpeted. 

The  detention  houses,  like  the  other  buildings,  have  nu- 
merous windows,  from  which  there  are  pleasant  outlooks. 
The  interiors  are  cheerful  and  are  comfortably  furnished. 
Nearly  all  of  the  limited  number  of  patients  in  the  detention 
house  for  women  were  engaged  in  sewing  or  knitting,  with 
an  attendant  in  their  midst.  As  we  entered,  a  request  was 
politely  made  to  abstain  from  note-taking  in  the  presence 
of  the  patients,  it  being  explained  that  pains  were  taken  to 
occupy  their  minds,  and  every  thing  likely  to  prove  a  cause 
of  disturbance  was  avoided. 

There  are  fourteen  isolation  rooms,  which  number  is  here 
considered  more  than  sufficient  for  an  asylum  having  six 
hundred  patients.  They  generally  stand  empty  in  the  day- 
time, and  at  night  are  used  for  sleeping-rooms  for  restless 
patients.     In  those  used  for  isolating   maniacal  cases  there 


286  ALT-SCHERBITZ. 

are  inside  blinds  to  the  windows.  The  isolation  apartments 
are  so  distributed  that  there  is  in  each  reception  station  two 
and  in  each  detention  department  five.  There  were  formerly 
three  rooms  for  isolation  in  each  observation  station,  but 
these  have  not  been  used  in  a  number  of  years  for  this  pur- 
pose. The  walls  shutting  off  the  grounds  from  the  observa- 
tion court  having  been  found  unnecessary,  were  removed. 

In  the  management  the  tendency  is  towards  an  extension 
of  the  liberty  of  the  patient.  Isolation  cannot  be  enforced 
without  the  consent  of  the  Superintendent,  who  said :  *'  It 
is  avoided  in  every  possible  case."  There  were  no  cribs  in 
use,  nor  were  there  any  padded  rooms.  Patients  who 
show  a  disposition  to  tear  off  their  clothing  are  attired 
in  strong  garments  buttoned  at  the  back.  This  dress  Dr. 
Paetz  does  not  regard  as  a  means  of  restraint.  He  says : 
"  It  does  not  hinder  the  patients  from  having  free  use  of  all 
their  members,  and  this  arrangement  of  the  clothing  only 
prevents  its  being  torn  off."  He  further  says  :  "  Every  sort 
of  restraint  by  force  is  strictly  interdicted  as  being  against 
the  fundamental  principles  of  the  asylum.  The  patients 
enjoy  the  largest  imaginable  freedom,  the  asylum  represent- 
ing the  non-restraint  system  in  its  widest  sense.  Restraint 
is  easy  to  dispense  with  if  one  earnestly  wishes  to  dispense 
with  it."  The  number  of  nurses  or  attendants  averages 
about  one  to  ten  patients.  They  live  with  the  patients  and 
lodge  in  the  same  dormitories. 

The  medical  department  appeared  to  be  thoroughly  sys- 
tematized. Every  patient  on  arrival  at  the  institution  must 
remain  in  bed  on  the  morning  after  reception  to  wait  a 
mental  and  bodily  inspection  by  the  whole  of  the  medical 
staff.  Each  physician  is  required  to  write  out  separately  his 
diagnosis  of  the  case,  giving  his  views  of  the  necessary  treat- 
ment.    These  become  matters  of  record. 


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DETENTION    HOUSE.     ALT-SCHERBITZ. 


COTTAGES  OR    VILLAS.  28/ 

Patients  who  do  not  occupy  the  central  institution  are 
provided  for  in  villas  and  other  dwellings.  Those  for 
women  are  widely  separated  from  those  for  men.  The  super- 
intendent's residence  and  grounds,  the  asylum  kitchen,  dairy, 
laundry,  and  farm  buildings  are  between.  An  assistant  phy- 
sician resides  in  one  of  the  cottages  belonging  to  the  group 
occupied  by  male  patients.  There  are  three  classes  of  cot- 
tages, or  villas.  The  first  and  second  classes  are  two-story 
buildings,  and  are  all  well  furnished,  the  quality  of  furniture 
varying  according  to  the  payment  for  support.  These 
buildings  stand  at  a  distance  of  about  one  hundred  yards 
apart.  From  the  most  of  them  glimpses  are  obtained  of  the 
river  Elster.  They  are  separated  from  each  other  by  neat 
low  hedges,  and  attached  to  some  of  them  are  little  gardens. 
There  are  no  guards  to  any  of  the  windows.  The  freedom 
of  the  place  is  shown  by  open  doors,  which  everywhere 
meet  the  eye.  It  was  a  pleasant  summer  day  when  I  was 
there,  and  the  patients  were  passing  in  and  out  without  in- 
terference, all,  however,  being  under  watchful  supervision. 

One  of  the  large  sitting  or  day  rooms  entered  contained 
a  circular  sofa  in  the  centre  and  an  ordinary  sofa  against  the 
wall.  On  the  floor  were  some  bright  rugs,  and  the  presence 
of  flowers  and  objects  of  ornamentation  lent  an  air  of  refine- 
ment to  the  whole  interior.  The  other  furnishing  included 
mirrors,  pianos,  wardrobe,  writing-desk,  sewing  tables,  divans, 
and  chests  of  drawers.  Lamps  were  suspended  from  the 
neatly  frescoed  ceiling.  The  walls  were  colored.  There  are 
convenient  store-rooms  and  closets  in  the  several  depart- 
ments. The  cottages,  all  of  Avhich  are  constructed  to  admit 
an  abundance  of  sunlight,  rest  on  dry,  substantial  founda- 
tions. 

A  third-class  two-story  cottage  accommodating  nineteen 
inmates  had  fewer  conveniences  than  the  others,  though  it 


288  ALT-SCHERBITZ. 

was  adequately  furnished.  On  the  lower  floor  is  the  sitting 
or  work  room,  also  the  dining-room  ;  and  on  the  upper  floor 
are  the  sleeping  apartments.  In  the  cottages '  as  also  in  the 
central  institution  '  the  arrangements  for  men  are  a  counter- 
part of  those  for  women.  It  is  the  aim  of  the  management 
to  have  every  thing  relating  to  the  care  and  treatment  of 
the  patients  conform  as  nearly  as  practicable  to  home  life. 

The  institution  cottages  in  the  adjacent  hamlet  of  Alt- 
Scherbitz  were  next  visited.  At  one  of  these  the  patient 
had  gone  out  and  locked  his  door,  and  the  physician  would 
not  enter  the  dwelling  without  his  permission.  These 
buff-colored  cottages  with  white  mouldings  present  a  neat 
exterior.  On  the  doors  are  the  names  of  the  patients  put 
on  by  themselves.  One,  manifesting  some  classical  taste, 
had  carefully  imprinted  in  large  characters  over  the  door  of 
his  little  cot  the  word  "  Salve."  The  furnishing  of  these 
houses  is  simple,  yet  sufiflcient  for  the  needs  of  the  inmates. 

Provision  for  sixty  harmless  and  infirm  chronic  insane  of 
each  sex  is  made  in  two  cottage  pavilions.  One  is  on  the 
right  and  the  other  on  the  left  of  a  dwelling  for  an  assistant 
physician  and  others  connected  with  this  department.  These 
buildings  form  a  separate  group  in  the  neighborhood  of  the 
central  institution.  They  are  two-story  structures  having 
associated  dormitories  on  the  upper  floor. 

There  is  one  general  kitchen  for  the  whole  establishment. 
The  food  is  conveyed  from  it  to  the  several  depart- 
ments. The  vehicle  containing  the  mid-day  meal,  and  con- 
structed so  as  to   keep  the  contents  warm,  was  seen   on  its 

'  While  the  plans  and  illustrations  given  of  some  of  the  Alt-Scherbitz  build- 
ings serve  the  valuable  purpose  of  demonstrating  the  feasibility  of  substituting 
inexpensive,  comfortable  structures,  something  like  ordinary  dwellings,  for 
the  generally  prevailing  massive  palatial  edifices  built  on  the  congregate  plan 
for  the  insane,  they  are  not  presented  as  faultless  models  for  asylums  in  the 
United  States. 


FOOD — HEATING — INDUSTRIES.  289 

way  from  the  kitchen  to  the  cottages.  Two  patients  were  in 
charge  of  it,  one  acting  as  driver  and  the  other  occupying  a 
seat  behind.  In  the  extensive  culinary  department  twelve 
patients  were  seen  at  work  under  the  supervision  of  an  at- 
tendant. Besides  these  general  arrangements  for  the  prepa- 
ration of  food,  it  should  be  mentioned  that  each  domicile 
has  its  scullery  and  pantry.  The  rule  as  to  food  specifies 
that  it  be  wholesome  and  well  prepared,  and  further,  that 
the  dishes  and  cooking  utensils  be  scrupulously  clean. 

The  central  department  is  warmed  by  hot  air ;  in  the 
isolating  apartments  the  heating  is  effected  by  hot-water 
pipes ;  in  the  villas  porcelain  stoves  are  generally  used, 
open  fires  supplementing,  to  some  extent,  the  system  of 
heating,  and  aiding  ventilation.  Water  is  elevated  by  a 
force-pump  and  distributed  by  gravitation.  The  bucket 
system  is  adopted,  and  all  waste  is  utilized  on  the  farm. 

The  farm  buildings  are  extensive,  and  a  large  herd  of  cows 
is  kept.  The  dairy,  quite  an  important  adjunct,  was  shown 
by  those  in  charge  with  justifiable  pride.  There  is  a  brick- 
yard on  the  place,  and  from  this  source  has  not  only  been 
supplied  brick  used  in  the  erection  of  asylum  buildings,  but 
a  considerable  quantity  has  been  marketed.  Other  objects 
of  interest  which  arrest  the  eye  are  a  capacious  hot-house,  a 
well-stocked  fish-pond,  also  an  orchard  in  which  are  cherry, 
pear,  apple,  and  plum  trees. 

Agreeable  employment,  suited  to  the  mental  and  bodily 
condition  of  the  patient,  with  relaxation  in  the  form  of  out- 
door and  indoor  games,  is  strongly  enjoined  by  the  man- 
agement as  a  means  of  cure,  and  is  carried  out  in  the 
domestic  department,  in  the  several  workshops,  in  the  gar- 
den, and  in  the  fields.  I  was  informed  that  from  eighty- 
five  to  ninety  per  cent  of  the  patients  were  on  the  list  of 
the    employed.      The    women    find    much  to   occupy  their 


290  ALT-SCHERBITZ. 

minds  and  energies  in  the  kitchen,  the  wash-house,  and  the 
dairy.  Many  work  in  the  sewing-room,  where  wearing 
apparel  is  made,  and  where  articles  for  institution  use  are 
repaired.  Some  of  them  milk  the  cows  and  work  in  the 
garden  or  in  the  fields.  Most  of  the  men  are  occupied  at 
agricultural  work  and  at  different  trades.  The  few  not 
engaged  in  any  form  of  employment  include  acute  cases 
under  medical  treatment,  those  physically  incapacitated,  also 
those  extraordinarily  excited.  "  There  is,"  says  Dr.  Paetz, 
"  no  branch  of  agricultural  work  in  which  the  patients  are 
not  useful,  and  their  use  of  implements  has  not  been 
attended  by  any  accident."  In  the  brick  and  tile  yards  only 
a  few  paid  laborers  in  addition  to  the  patients  are  required 
to  do  the  work.  This  is  also  the  case  in  the  other  depart- 
ments. In  addition  to  the  insane  at  work  on  the  farm 
and  in  the  brick-yard,  others  were  employed  as  joiners, 
masons,  wagon-makers,  blacksmiths,  carpenters,  smiths,  shoe- 
makers, tailors,  saddlers,  book-binders,  stone-masons,  painters, 
basket-makers,  and  clerks. 

In  furtherance  of  their  recovery  all  the  curable  insane 
within  this  institution  have  equal  care  and  consideration. 
Excursions  for  the  benefit  of  the  health  of  the  inmates  are 
periodically  made,  and  in  the  case  of  the  poorer  patients  the 
asylum  bears  the  cost.  Theatrical  entertainments,  concerts, 
dances,  bowling,  and  a  variety  of  games,  are  among  the 
varied  means  of  recreation  and  amusement.  Particular 
attention  is  paid  to  cleanliness  of  the  person  and  of  the 
clothing.  The  latter  is  frequently  changed,  and  the  airing 
of  all  apartments  is  not  a  matter  of  hap-hazard,  but  of  rule. 
A  spacious  swimming-bath  is  provided  for  the  inmates  in 
the  river  Elstcr.  The  correspondence  of  patients  with  out- 
siders is  regulated  by  the  asylum  superintendent.  The 
statute  provides  that  complaints  of  want  of  proper  care  and 


TACT  IN  MANAGEMENT.  29 1 

treatment  may  be  made  to  the  "  Landes  Director,"  and  that 
charges  of  a  grave  nature  may  be  brought  to  the  attention 
of  the  Provincial  Committee.  Strangers  are  admitted  to 
the  institution  only  by  permission  of  the  superintendent, 
and  he  may  deny  the  admission  of  a  relative  if  he  thinks  the 
visit  likely  to  be  injurious  to  the  patient.  Care  is  taken  to 
prevent  annoyance  to  the  inmates. 

At  this  institution  one  is  favorably  impressed  with  the 
absence  of  barriers,  the  freedom  from  restraint,  the  kind 
treatment  accorded  the  patients,  the  thorough  supervision 
of  the  large  numbers  occupied  in  the  various  employments, 
the  general  atmosphere  of  cheerfulness  and  quiet,  and  the 
cleanliness  and  country-life  aspect  of  the  place.  One  in- 
stance illustrative  of  the  intelligent  management  may  be 
cited.  In  the  laundry  were  observed  a  large  number  of 
women  working  at  tubs  with  wash-boards.  A  few,  however, 
stood  idle  and  listless,  with  their  untouched  work  before 
them.  On  inquiring  of  the  physician  why  these  patients 
were  so  placed  while  doing  nothing,  he  replied  :  "  They  may 
be  there  for  days  and  not  raise  a  hand  to  work,  but  by  and 
by  the  mind  becomes  interested,  a  slight  effort  is  put  forth, 
followed  by  another  and  yet  another,  until,  at  length,  they 
become  steady  workers,  and  as  a  consequence  their  health 
is  greatly  improved."  Such  careful  endeavor  to  engage  the 
mind  and  induce  volition  on  the  part  of  the  insane  by  kind 
and  patient  effort  is  a  fundamental  principle  of  the  Alt- 
Scherbitz  treatment. 

Without  any  attempt  at  ambitious  architectural  display 
or  costly  interior  furnishing,  there  is,  apparently,  in  this  in- 
stitution every  thing  essential  to  the  comfort  of  the  insane. 
The  whole  system  of  care  and  treatment  seems  adapted  to 
insure  highly  satisfactory  results  ;  and  yet  a  stranger  pass- 
ing along  the  highway  and  catching  glimpses  of  the  asylum 


292  ALT-SCHERBITZ. 

buildings  through  the  trees  and  shrubbery,  would  hardly- 
suspect  from  their  unpretentious  character  and  their  arrange- 
ment upon  the  estate  that  the  place  was  a  public  hospital 
and  asylum  for  insane  people. 


CHAPTER  VIII. 
RESUME. 

A  GENERAL  survey  of  the  field  of  inquiry  to  which 
the  reader's  attention  has  been  directed  in  the  fore- 
going pages  suggests  some  thoughts  which  it  may  not  be  out 
of  place  to  present,  with  a  few  conclusions  drawn  not  only 
from  this  examination,  but  from  other  extended  examina- 
tions of  various  methods  of  caring  for  the  insane. 

LOCATION. 

It  has  been  found  in  many  instances  that  essentials  to  the 
good  sanitary  condition  of  an  asylum  and  an  economical 
administration  of  its  affairs  were  overlooked  in  selecting  the 
site  ;  and  consequently  the  institution  must  suffer  throughout 
its  existence  from  mistakes  that  cannot  be  rectified. 

The  first  consideration  in  the  selection  of  a  site  should  be 
its  healthfulness.  There  should  be  an  abundant,  never-failing 
supply  of  pure  water,  opportunity  for  the  ready  disposal  of 
sewage  without  endangering  the  health  of  the  inmates  or  of 
the  public  by  the  pollution  of  streams  or  otherwise,  a  suffi- 
cient acreage  of  land,  and  easy  communication  by  rail  or  water 
for  both  passengers  and  freight.  The  atmosphere  should  be 
pure  and  salubrious — free  from  malarial  influences  and  arti- 
ficial poisons.  The  situation  should  not  be  in  proximity  to 
any  local  nuisance  or  disturbing  element.  Although  not  al- 
ways practicable  to  obtain  without  sacrificing  more  impor- 
tant advantages,  it  is  desirable  that  water  be  supplied  from  a 

293 


294  j?£sum£. 

source  sufficiently  elevated  to  ensure  its  distribution  through- 
out the  various  buildings  by  gravitation.  The  supply  should 
equal  at  least  sixty  gallons  a  day  for  each  inmate. 

Many  of  the  asylums  formerly  built  for  the  insane  were 
established  within  or  adjacent  to  populous  centres,  where  it 
was  difficult  to  obtain  sufficient  land  for  gardening  and  farm- 
ing purposes.  This  disadvantage  led  to  a  change  of  policy, 
and  modern  mixed  asylums  and  those  for  the  chronic  insane 
are  more  generally  located  in  the  country  and  upon  con- 
siderable tracts  of  land.  Nevertheless,  it  seems  to  be  almost 
universally  the  case  that  additional  land  is  soon  required, 
and  it  is  frequently  impossible  to  obtain  it,  even  at  an  exor- 
bitant price. 

In  order  to  overcome  some  of  the  difficulties  arising  from 
lack  of  sufficient  landed  estates  in  connection  with  institu- 
tions for  the  insane  in  England,  the  Government  has  made  it 
practicable  for  one  county  to  purchase  land  and  establish  an 
asylum  in  another  county.  It  is  often  found  necessary  to 
adopt  the  unsatisfactory  plan  of  leasing  ground,  sometimes  at 
inconvenient  distances  from  the  asylum  property.  From  past 
experience  may  be  learned  the  lesson  that  it  is  always  best, 
when  founding  an  asylum,  to  secure  at  the  outset  sufficient 
land.  If  more  should  be  purchased  than  is  actually  required, 
it  could  be  sold  at  a  profitable  advance,  as  the  improve- 
ments and  high  cultivation  would  increase  its  value.  The 
area  of  land  for  an  institution  for  the  chronic  insane  should 
not  be  less  than  one  acre  per  inmate.  There  are  those  who 
think  half  this  amount  is  sufficient ;  but  the  weight  of  testi- 
mony is  in  favor  of  the  larger  acreage.  Some  American 
authorities  place  it  as  high  as  two  and  even  three  acres  per 
inmate. 

It  is  conceded  that  agreeable  occupation,  especially  em- 
ployment in  the  open  air,  greatly  contributes  to  the  health 


LOCA  nOAT.  295 

and  contentment  of  the  insane  ;  and  it  has  been  demon- 
strated that  the  rate  of  maintaining  the  chronic  insane  is 
lowered  as  the  quantity  of  land  is  increased  ;  while  in  some 
instances,  with  a  larger  acreage,  a  higher  dietary  stand- 
ard is  attained.  At  Alt-Scherbitz  in  Prussia,  Clermont 
in  France,  and  the  Willard  Asylum  in  the  State  of  New 
York,  we  find  extensive  vegetable  gardens,  goodly  sized  fruit 
orchards,  wide  fields  yielding  grain,  and  broad,  rich  meadows. 
The  large  herds  of  cattle  kept  at  these  places  produce 
abundant  milk,  butter,  cheese,  and  beef,  for  the  consump- 
tion of  the  inmates. 

Another  advantage  in  having  a  liberal  area  of  land  is 
found  in  the  opportunity  afforded  for  reserving  broad  spaces 
for  lawns  and  shady  groves  exclusively  for  the  exercise  and 
recreation  of  the  patients,  and  for  making  a  wider  distri- 
bution of  the  various  buildings,  which  is  desirable  in  effecting 
a  proper  classification  of  the  insane. 

Not  only  is  a  large  acreage  of  land  desirable,  but  its  qual- 
ity is  of  great  importance.  That  suited  to  gardening  pur- 
poses seems  best  adapted  for  the  uses  of  an  insane  asylum. 
The  soil  should  be  a  warm  fertile  loam  that  may  be  culti- 
vated early  and  late  in  the  season  for  doing  outdoor  work — 
one  that  soon  becomes  dry  after  rain,  and  is  thus  suitable 
for  recreation  the  greatest  possible  number  of  days  in  the 
year.  It  is  much  more  agreeable  to  till  good  land  than  that 
which  is  poor,  and  the  former  will  often  return  for  the  same 
amount  of  seed  and  labor  double  the  harvest  of  the  latter. 
Clay  land  and  that  which  is  stony  should  be  rejected.  Using 
the  spade  or  plough  on  such,  especially  the  latter,  while 
trying  the  patience  of  a  sane  man,  irritates  the  insane.  A 
loamy  soil  by  its  absorbing  qualities  takes  up  impurities, 
thus  acting  in  some  degree  as  a  disinfectant,  and  pre- 
serving a  purer  and  more  wholesome  atmosphere.     Further, 


296  R^SUM^. 

when  a  large  outlay  in  buildings  is  contemplated,  it  is  un- 
wise to  place  them  on  land  other  than  that  in  every  way 
suited  to  the  purpose  for  which  it  is  intended.  The  im- 
mediate site  of  all  buildings  should  be  on  ground  free  from 
hidden  springs,  and  capable  of  quick  surface  and  effectual 
sub-drainage.  A  rocky  substratum  should  be  avoided,  for 
it  makes  necessary  excavations  expensive. 

The  love  of  the  beautiful  in  nature  is  common  to  man- 
kind, and  though  it  may  not  always  be  manifest,  its  peace- 
ful influence  is  felt,  in  a  greater  or  less  degree,  by  the  in- 
sane as  well  as  the  sane.  Residents  of  the  country,  like 
those  of  the  city,  seek  opportunities  for  recreation  in 
the  summer  where  nature  is  specially  alluring,  and  this 
fact  should  not  be  lost  sight  of  in  selecting  places  for  the  care 
of  the  mentally  diseased.  A  site  commanding  an  extensive 
and  varied  prospect  that  tends  to  inspire  pleasurable  emo- 
tions in  the  mind,  should  therefore  be  sought.  For  a 
strictly  curative  institution — that  is  to  say,  for  a  hospital  for 
the  insane,  where  so  large  a  tract  of  land  as  is  requisite  for  an 
asylum  is  not  necessary,  nearness  to  a  city  or  a  large  town  is 
desirable. 

In  locating  public  charitable  institutions,  the  State  has  not 
infrequently  accepted  donations  of  land  made  by  local  author- 
ities or  through  the  voluntary  subscriptions  of  private  citi- 
zens. It  has  invariably  resulted  that  this  temporary  gain 
has  proved  a  permanent  disadvantage.  By  whatever  name 
we  call  it,  a  gift  of  this  character  partakes  of  the  nature  of  a 
bribe,  and  its  acceptance  creates  the  feeling  that  an  equitable 
claim  is  thus  established  for  the  patronage  of  the  institu- 
tion ;  and  if  this  be  denied,  ill-feeling  and  embarrassment  to 
the  management  ensue.  The  result  is  more  satisfactory 
when  the  State  makes  its  selection  on  the  merits  of  the  site, 
irrespective  of  local  gifts;  and  it  is  certainly  more  dignified 


BUILDINGS.  297 

to  do  SO  than  to  appear  as  a  suppliant  before  a  portion  of 
its  people.  It  would  be  well  if  every  State  should  follow  the 
example  of  Illinois,  and  forbid  the  free  acceptance  by  com- 
missions, of  sites  for  public  buildings. 

BUILDINGS. 

In  making  provision  for  the  insane,  we  should  not  over- 
look the  fact  that  there  are  two  general  classes  or  divisions 
— the  acute  and  the  chronic.  Respecting  the  first,  there 
exists,  in  a  greater  or  less  degree,  the  expectation  of  cure  ; 
in  regard  to  the  second,  the  chance  of  recovery  is  reduced,  it 
may  be  said,  to  a  bare  possibility.  To  the  chronic  class 
belongs  the  great  mass  of  insane  under  care,  variously  esti- 
mated at  from  four  fifths  to  seven  eighths  of  the  whole. 

Every  consideration  of  humanity  demands  that  no  time 
should  be  lost  in  applying  remedial  measures  when  they  are 
most  efBcacious,  and  that,  however  elaborate  the  provision 
or  expensive  the  treatment,  no  effort  should  be  spared  to  cure 
the  patient  before  the  disease  becomes  chronic.  Not  only 
does  every  principle  of  humanity  require  this,  but  herein  is 
true  economy ;  for,  if  an  insane  person  can  be  cured  before 
the  acute  period,  which  is  comparatively  brief,  is  passed, 
though  the  treatment  be  highly  expensive,  it  is  cheaper  to  do 
so  than  to  maintain  him  during  the  following  twelve  or  more 
years  of  his  life  in  the  chronic  state,  even  if  it  be  at  a  low 
rate  of  maintenance. 

Past  experience,  it  appears  to  me,  has  demonstrated  that 
large  mixed  institutions  are  not  effective  agencies  in  the 
cure  of  insanity.  In  many  particulars  the  requirements  of 
the  acute  insane  are  more  exacting  than  those  of  the  chronic. 
These  include  special  structural  arrangements,  very  close 
medical  attention,  a  large  corps  of  specially  qualified  at- 
tendants,  and    a   prescribed    diet.      If    a  standard    of    care 


298  RESUME. 

suitable  to  the  necessities  of  the  acute  insane  is  adopted 
by  a  large  institution  receiving  both  acute  and  chronic 
cases,  it  is  unnecessarily  expensive  for  the  chronic  in- 
sane ;  if  the  standard  is  made  only  conformable  to  the 
needs  of  the  chronic,  it  is  insufficient  for  the  acute  in- 
sane :  and  it  has  been  found  difficult  to  counteract  the 
tendency  towards  a  uniform  standard  of  care  for  both 
classes  under  the  same  administration.  Besides,  a  great 
number  of  patients  increases  the  business  responsibility  of 
the  superintendent  and  demands  attention  that  should  be 
given  to  the  medical  department,  multiplies  details,  and 
finally  individuality  is  lost,  and  the  curative  purpose  of  the 
institution,  which  should  be  paramount  to  every  thing  else, 
cannot  be  effectually  carried  out. 

It  is  the  opinion  of  the  Hon.  Francis  Scott,  for  twenty 
years  chairman  of  the  Brookwood  Asylum  Board,  that 
efficient  superintendence  is  rendered  impossible  in  what  he 
calls  monstrous  asylums,  and  that  such  institutions  are  most 
unfavorable  to  the  treatment  and  cure  of  insane  patients, 
and  their  management  harassing  and  unsatisfactory  to  the 
medical  superintendent.  He  says  :  "  The  doctors  in  large 
asylums  cannot  even  know  the  patients  by  sight,  much 
less  by  name.  The  thread  of  their  history  is  to  them  a 
tangled  skein  which  they  scarcely  attempt  to  unravel.  The 
admixture  of  a  curable  patient  with  the  vast  common  herd 
has  a  most  detrimental  effect." 

Dr.  Rayner  of  Hanwcll  complains  of  his  large  asylum. 
He  says:  "  I  cannot  see  all  my  patients  in  one  day."  And 
yet  this  very  evil  consequent  upon  overgrowth  was  at  the 
beginning  protested  against  by  the  English  Lunacy  Board. 
Its  chairman,  Lord  Shaftesbury,  said  before  the  parliamen- 
tary committee  of  1877  :  "  My  own  opinion  has  always  been, 
and  from  the  first  time  I  was  acquainted  with  lunacy  I  have 


BUILDINGS.  299 

always  maintained,  that  three  hundred  was  the  outside  that 
could  be  well  managed  by  one  superintendent.  There  is  a 
desirable  process  which  the  Germans  call  the  individualizing- 
system.  With  more  than  three  hundred  it  would  be  impos- 
sible that  the  medical  superintendent  could  personally  see 
each  patient,  as  he  ought  to  do,  several  times  in  the  course 
of  the  week.  We  had  a  very  long,  not  to  say  very  angry, 
controversy  with  Hanwell  at  the  time  that  they  enlarged 
their  buildings.     We  were  very  averse  to  that  scheme." 

It  seems  to  be  necessary  that  every  State  should  provide 
sufficient  accommodation  for  its  acute  insane  in  small 
hospitals,  where,  under  influences  favoring  restoration  to 
health,  recent  cases  could  be  made  the  subject  of  close  study 
by  skilful  alienists,  and  where  every  possible  means  would 
be  brought  into  requisition  to  effect  cure,  the  ever-recurring 
question  of  expense  being  a  secondary  consideration.  Only 
in  this  way  can  we  expect  to  lessen  the  steadily  increasing 
volume  of  hopeless  insanity. 

It  must  be  conceded,  however,  that  it  has  heretofore  been 
found  very  difficult  to  establish  small  hospitals,  or  those 
even  of  moderate  size,  especially  designed  for  and  adapted 
to  curative  purposes.  After  such  a  project  has  been  under- 
taken, and  the  Legislature  has  decided  upon  the  site  for  a 
hospital,  the  work  of  building  devolves  upon  a  Board  of 
which  perhaps  not  a  single  member  has  made  previous  study 
of  the  special  needs  of  the  class  to  be  provided  for.  An 
architect  is  employed  who  sets  out  to  design  an  imposing 
building  that  will  stand  as  an  enduring  monument  to  his 
architectural  talent,  rather  than  one  best  adapted  for  the 
care  and  cure  of  the  insane.  In  his  attempt  to  plan  a  grand 
edifice  he  is  encouraged  by  those  representing  local  interests, 
who  desire  a  structure  that  will  by  its  stateliness  prove  an 
object  of  admiration  to  strangers  ;  and  so,  at  the  outset,  we 


300  R&SUM^. 

sometimes  expend  vast  sums  on  immense  buildings  that 
have  the  semblance  of  palatial  prisons.  Later  on,  other 
difficulties  arise.  More  accommodation  is  needed,  and  while 
it  is  plain  that  the  interests  of  the  insane  require  another 
asylum  rather  than  additions  to  the  existing  one,  pride  in 
administering  the  affairs  of  a  large  institution,  combined 
with  influences  arising  from  the  benefits  of  local  patronage, 
is  powerful  in  swelling  the  accommodations,  regardless  of  the 
purpose  of  the  establishment  and  its  original  plan.  Enlarge- 
ment follows  enlargement,  until  the  institution  finally  reaches 
enormous  dimensions,  and  whatever  principles  of  cure  were 
had  in  view  at  the  outset,  they  are  overwhelmed  and  ren- 
dered impracticable  by  the  aggregation  of  numbers. 

In  the  dominance  of  the  architectural  idea  over  the 
medical  and  moral  in  asylum  building,  we  frequently  behold 
a  vast  pile  of  brick  and  stone  and  mortar,  in  which  are 
congregated  a  great  number  of  mentally  diseased  persons, 
to  every  one  of  whom  the  surroundings  are  unnatural. 
Having  brought  them  into  abnormal  conditions  of  living,  the 
human  mind  is  taxed  to  the  utmost  to  overcome  these 
and  secure  requisites  to  health,  including  a  sufficiency  of 
light  and  air.  When  we  consider  the  distress  of  a  patient 
placed  in  one  of  our  immense  hospitals  built  on  the 
congregate  plan,  and  subjected  to  the  disquiet,  unhappiness, 
and  irritability  consequent  upon  the  herding  together  of 
masses  of  people,  the  wonder  is  that  we  should  attempt  his 
cure  under  circumstances  that  would  seemingly  cause  a  sane 
person  to  lose  his  reason. 

The  plan  of  a  hospital  for  the  acute  insane  I  would  have 
include  a  central,  unpretentious  building  for  the  superin- 
tendent. This  should  also  contain  the  offices  and  other 
apartments  customarily  belonging  to  what  is  known  as 
the    administration     department.     For    the   patients,  there 


BUILDINGS.  301 

should  be  cottages  so  arranged  that  the  superintendent's 
residence  and  central  department  will  stand  between  the 
groups  for  men  and  those  for  women.  The  cottages  should 
be  of  different  sizes  and  variously  designed,  all  of  them  re- 
sembling private  dwellings.  Assistant  medical  officers  should 
reside  in  some  of  the  cottages  with  the  patients.  There 
should  also  be  accommodation  in  each  cottage  for  the 
necessary    attendants. 

Reception  cottages  should  be  built  in  connection  with 
every  hospital  for  the  acute  insane.  A  fearful  shock  is  felt 
by  many  patients  when  first  brought  into  an  immense 
prison-like  building,  and  ushered  into  a  long,  formal  hall  or 
corridor  furnished  with  angular  wooden  chairs  and  settees, 
ranged  against  the  walls  much  like  the  waiting-room  of  a 
railroad  station.  Besides,  the  grating  sound  of  strong  locks, 
the  sight  of  heavy  doors,  barred  windows,  and  the  strange- 
acting  beings  who  gather  around  the  new-comer  are  not  likely 
to  calm  an  excited  mind.  First  impressions  are  lasting,  and 
should  be  agreeable.  They  are  more  likely  to  be  so,  if  the 
patient,  when  entering  a  hospital,  approaches  a  pleasant  cot- 
tage situated  in  park-like  grounds,  and,  instead  of  the  formal 
ward  with  its  strange  sights,  is  received  into  what  is  appar- 
ently an  ordinary  dwelling  with  homelike  furnishings.  Thus 
placed,  the  patient  feels  more  at  ease,  and  the  physician  can, 
for  this  reason,  get  at  a  better  understanding  of  his  case. 
Explanations  as  to  what  is  for  his  best  interest  are  made,  his 
apprehensions  allayed,  confidential  relations  established  be- 
tween him  and  the  physician,  and,  sooner  or  later,  according 
to  circumstances,  he  is  transferred  to  the  proper  department. 
One  thus  entering  a  hospital  for  the  insane,  I  am  assured,  is 
far  more  likely  to  be  reconciled  to  his  confinement,  and,  if 
curable,  is  sooner  placed  on  the  road  to  recovery. 

In  addition  to  reception  cottages,  there  should  be  separate 


302  RESUME. 

buildings  for  convalescing  patients.  These  should  be  like 
ordinary  dwellings,  and  pleasantly  situated.  They  should 
be  comfortably  furnished,  and  have  every  attraction  that 
could  agreeably  engage  the  mind.  It  is  asserted  by  a  high 
authority  that,  when  patients  begin  to  mend,  the  process  of 
cure  is  rapidly  accelerated  by  removing  them  from  the  dis- 
tressing associations  connected  with  the  first  period  of  their 
disease  to  entirely  new  surroundings. 

If  food  is  conveyed  from  a  general  kitchen  to  the  several 
separate  establishments,  as  at  Alt-Scherbitz,  or  if  each  cot- 
tage has  its  own  kitchen,  connecting  corridors  are  not 
necessary.  The  latter  plan  presents  the  nearer  approach  to 
family  life,  and  appears  to  be  the  more  desirable  arrange- 
ment for  hospitals  for  the  acute  insane.  In  either  case  there 
is  no  arbitrary  rule  as  to  the  relative  position  of  the  cottages 
and  the  central  building,  except  that  the  former  should  not 
be  too  far  away  for  convenient  supervision.  They  may  be 
located  with  reference  to  the  grade  of  the  land,  to  pleasant 
outlooks  that  may  be  had  from  them,  or  to  picturesque 
effects.  In  any  event,  they  should  be  placed  far  enough  apart 
to  give  the  appearance  of  retirement  that  may  be  attained 
by  the  judicious  planting  of  trees  and  shrubbery  between 
them.  If  corridors  are  considered  necessary,  they  should 
extend  backward  from  the  central  building  and  afford  com- 
munication with  such  departments  as  are  in  the  rear  of  it, 
and  thence  to  right  and  left  a  short  distance  from  the 
cottages,  connecting  with  the  rear  of  each  of  them  by  a 
branch  section.  An  illustration  of  the  way  in  which  sep- 
arate buildings  may  be  thus  connected  is  seen  in  the  new 
asylum  at  Mcnstone,  England. 

Many  of  the  old  congregate  asylums  are  so  arranged  that, 
to  reach  the  most  distant  parts  of  the  institution  from  the 
administration  or  central  department,  it  is  necessary  to  pass 


BUILDINGS.  303 

through  every  intervening  sitting  or  day  room  on  one  of  the 
asylum  floors.  Thus  a  monotonous  tramping  is  kept  up, 
which,  on  visiting  days  especially,  is  a  constant  source  of 
disturbance  to  irritable  and  nervous  patients.  In  every 
arrangement  of  buildings  such  an  annoyance  should  be 
avoided.  A  common  error  in  asylum  building  is  made  by 
connecting  separate  divisions,  blocks,  or  dwellings  by  means 
of  corridors  at  either  end.  It  should  be  kept  in  mind  that 
the  best  rooms  are  at  the  ends  of  a  building,  and  they  should 
not  be  spoiled  by  a  corridor  entrance  at  one  end  and  exit  at 
the  other.  If  such  passage-ways  are  deemed  necessary,  they 
should  be  so  planned  that  persons  may  pass  from  the  admin- 
istration building  to  any  one  of  the  separate  buildings  with- 
out finding  it  necessary  to  enter  any  other  than  the  one  they 
intend  to  visit. 

The  problem  how  to  dispose  of  the  chronic  insane  so  that 
they  shall  have  suitable  asylum  care  without  interfering 
with  the  strictly  curative  functions  of  the  hospital,  has  not 
yet  been  satisfactorily  solved  in  England,  Ireland,  or  Scot- 
land ;  and  the  remedial  powers  of  many  otherwise  good  insti- 
tutions, particularly  in  England  and  Ireland,  are  seriously 
interfered  with  by  the  excessive  accumulation  of  chronic 
patients.  The  Visiting  Magistrates  of  Haywards  Heath 
Asylum,  in  one  of  their  reports,  say:  "The  Committee  are 
strongly  of  the  opinion  that  our  county  asylums  are  losing 
the  character  and  the  objects  for  which  they  were  primarily 
intended,  namely,  as  places  for  the  sanitary  treatment  and 
cure  of  insane  persons,  and  arc  becoming  in  a  great  degree 
mere  receptacles  for  chronic  and  imbecile  patients  who  are 
detained  within  their  precincts ;  and  this  state  of  affairs 
greatly  interferes  with  the  due  separation  of  the  different 
forms  of  insanity  so  essential  to  the  alleviation  or  the  cure 
of  brain  disease."     They  further  add  that  county  or  district 


304  RESUME. 

asylums  should  be  used  "  solely  for  the  reception  of  acute 
and  violent  cases,  of  those  requiring  special  treatment,  and 
those  affording  the  hope  of  cure  ;  and  that  provision  should 
be  made  for  the  reception  of  aged  and  harmless  insane 
persons  in  buildings  specially  adapted  for  their  comfort 
and  careful  treatment,  but  constructed  and  conducted  at  a 
considerable  less  cost  than  our  present  asylums,  and  involving 
a  much  smaller  expenditure  to  the  rate-payers." 

In  Scotland,  relief  to  a  large  extent  has  been  found 
in  the  boarding-out  system.  In  England  and  Ireland,  a  re- 
sult of  overcrowding  in  institutions  originally  designed 
for  curative  purposes  has  been  to  bring  great  numbers  of 
the  chronic  insane  under  the  unsatisfactory  care  of  the  work- 
house. 

The  embarrassment  arising  from  the  overwhelming  num- 
bers of  chronic  insane  in  mixed  asylums  was  very  great 
in  every  country  that  I  visited.  A  similar  difficulty  is  be- 
coming formidable  in  the  United  States,  and  there  is  no 
doubt  but  that  it  will  continue  to  increase  as  the  country 
grows  older,  unless  a  wise  and  comprehensive  policy  is 
adopted  respecting  this  rapidly  accumulating  class.  The 
weakening  of  the  effectiveness  of  curative  institutions  by 
the  continuous  inorease  of  chronic  cases,  and  the  insuffi- 
cient provision  for  their  care  in  pauper  establishments, 
leads  me  to  conclude  that,  in  order  to  meet  these  difficulties, 
we  must  have  more  institutions  of  the  character  of  asylums 
for  the  chronic  insane,  or  for  those  who  have  received 
thorough  treatment  in  a  well-organized  hospital.  In  the 
asylum,  nevertheless,  the  hope  of  recovery  should  always 
be  kept  in  mind,  and  the  idea  of  incurability  ignored. 
Such  institutions  should  not  be  designated  as  chronic 
or  incurable,  but  simply  as  asylums  in  contradistinction  to 
hospitals. 


BUILDINGS.  305 

As  already  stated,  asylums  should  be  located  on  consid- 
erable tracts  of  good  arable  land.  The  buildings  should  be 
simple  and  inexpensive.  At  the  same  time,  they  may  be 
made  attractive  by  varied  outline  and  color.  Adjacent  to 
the  administration  department  there  should  be  sufficient 
hospital  provision  for  those  requiring  special  care.  Beyond 
this,  there  should  be  a  wide  distribution  of  buildings  on  the 
colony  plan.  These,  with  their  surroundings,  should  be  made 
to  approach  as  nearly  as  practicable  to  ordinary  homes. 

While  there  are  conclusive  reasons  why  hospitals  for  the 
acute  insane  should  be  small,  these  reasons  have  not  the 
same  force  when  applied  to  asylums  for  the  chronic  insane. 
In  fact,  there  are  some  advantages  that  may  be  gained  in 
bringing  together  a  considerable  number  of  this  class.  The 
opportunity  is  thus  afforded  of  extended  classification,  of 
making  up  groups  of  artisans  under  a  master  workman,  of 
purchasing  supplies  in  large  quantities  at  low  rates,  of  re- 
ducing the  cost  of  superintendence,  and  otherwise  lessening 
the  expense  of  maintenance.  But  the  almost  irresistible 
tendency  to  undue  aggregation  is  a  danger  that  should  be 
carefully  guarded  against  even  in  providing  for  the  chronic 
insane. 

The  architecture  of  British  asylums  is  without  elaborate 
ornamentation.  The  prevailing  opinion  now  seems  to  be  in 
favor  of  two-story  buildings  for  most  classes  of  the  insane. 
Even  on  the  score  of  economy,  little  if  any  thing  can  be  said 
in  favor  of  a  greater  height,  for  although  the  same  roof  that 
would  be  required  for  a  two-story  building  suffices  for  the 
three-story  structure,  the  foundation  walls  of  the  latter  are 
necessarily  more  massive  than  those  of  the  former,  the  entire 
edifice  must  be  stronger,  and  additional  expenditures  in  these 
directions  considerably  increase  the  expense  of  a  three-story 
building,  so  that  its  per-capita  cost  of  accommodation  is  nearly 


306  RESUME. 

or  quite  the  same  as  that  of  a  two-story  structure.  As  an  off- 
set to  the  possibly  slight  advantage  gained  in  the  reduced  per- 
capita  cost  of  construction,  there  are  the  disadvantages  arising 
from  an  extra  flight  of  stairs,  including  the  greater  difficulty 
of  escape  in  case  of  fire.  The  general  form  of  modern  con- 
struction admits  of  the  upper  portion  being  set  apart  almost 
exclusively  for  night  use.  The  sleeping-rooms  are  unoccu- 
pied during  the  day,  the  windows  open,  and  the  bedding 
disposed  for  airing  for  a  considerable  time.  By  this  arrange- 
ment the  labor  of  the  women  can  be  utilized  in  putting  in 
order  the  men's  dormitories,  and  the  change  incident  to 
separate  day  and  night  accommodation  is  conducive  to 
healthfulness. 

A  mistake,  and  one  which  the  builders  of  American 
asylums  sometimes  make,  was  occasionally  found  abroad  in 
the  failure  to  carry  up  the  cellar  or  foundation  walls  suffi- 
ciently high  to  allow  of  a  quick  descending  grade  about  the 
building,  so  as  to  carry  off  the  water  from  storms  that  beat 
against  the  walls  above.  From  this  omission  is  likely  to 
result  damp  foundations,  which  affect  deleteriously  the  sani- 
tary condition  of  living  apartments. 

The  rule  of  the  English  Commissioners  in  Lunacy  respect- 
ing air  space  in  asylum  buildings  having  ceilings  twelve  feet 
high  is,  that  the  associated  dormitories  for  clean  and  healthy 
patients  shall  have  fifty  superficial  feet  of  floor  space  to  each 
bed,  the  separate  sleeping-rooms  at  least  sixty-three  super- 
ficial feet,  and  that  rooms  occupied  by  sick  or  bedridden 
patients  must  have  larger  space  with  extra  means  of  venti- 
lation, that  day-rooms  must  have  not  less  than  forty  square 
feet  of  floor  space  to  each  person,  and  that  a  detached  hos- 
pital for  contagious  cases  must  have  fifteen  hundred  cubic 
feet  of  air-space  to  each  bed. 

The    commissioners    recommend   that   to    each   ward    or 


BUILDINGS.  307 

group  of  patients  there  be  accommodation  for  two  attend- 
ants, that  their  single  rooms  measure  one  hundred  feet  of 
floor  space,  and  that,  when  practicable,  their  rooms,  with 
glazed  doors  for  observation,  be  placed  between  two 
associated  dormitories  ;  also  that  day-rooms  for  sick,  aged, 
infirm,  and  excited  patients  should  be  on  the  first  floor,  and 
that  no  associated  bedrooms  contain  less  than  three  beds. 

As  affording  greater  security  against  fire,  the  commis- 
sioners advise  that  ceilings  of  rooms  next  below  the  roof 
be  made  of  incombustible  materials,  and  that  buildings  be 
semi-fireproof,  or  at  least  so  constructed  that  a  fire  occurring 
in  one  part  may  be  extinguished  without  destroying  another 
part  of  the  building;  also  that  stairs  be  built  of  stone,  with 
square  landings,  and  the  wall  built  up  with  hand-rails  on 
each  side.  They  insist  that  there  must  be  a  sufificient 
number  of  stairways,  and  that  they  be  so  placed  as  to 
afford  ready  egress  in  case  of  fire. 

The  commissioners  advise  that  windows  be  large  ;  that  in 
day-rooms  they  be  not  more  than  three  and  a  half  feet  from 
the  ground,  and  in  dormitories  not  more  than  four  feet  from 
the  floor  ;  that  in  single  rooms  they  be  stopped  so  as  not  to 
open  more  than  five  inches  at  top  and  bottom,  and  that  a 
portion  of  them  have  strong,  inside  shutters  so  made  that 
they  cannot  be  forced  open  nor  afford  means  of  commit- 
ting suicide  by  hanging;  and  that  doors  of  single  rooms 
open  outward  and  fold  close  against  the  wall.  They 
are  of  the  opinion  that  for  about  one  seventh  of  the  pa- 
tients in  an  asylum  "infirmary"  accommodation  should  be 
provided  with  abundant  air-space,  each  room  having  an 
open  fire  or  fires  and  a  small  diet  kitchen  ;  also  that  open 
fire-places  should  be  built  in  all  the  large  rooms,  dormitories, 
and  a  portion  of  the  single  rooms,  and  that  there  should 
be  other  means  of  heating  besides  that  of  open  fires.     They 


308  R&SUM^. 

recommend  that  there  be  a  separate  wash-house  for  very 
foul  clothes,  and  a  room  for  washing  and  drying  the 
horse-hair  of  the  mattresses  ;  that  there  be  an  abundance 
of  closet  and  store-room  space,  also  conveniently  arranged 
workshops  well  lighted  and  ventilated. 

Some  of  the  best  English  asylums  are  so  constructed  that 
the  sewers  do  not  enter  nor  pass  under  inhabited  buildings, 
but  terminate  close  to  the  wall  in  a  ventilating  flue  after 
passing  a  syphon  trap.  In  this  way  it  is  not  possible  for 
foul  odors  from  the  sewers  to  contaminate  the  atmosphere 
of  living  apartments.  All  soil  and  waste  pipes  are  carried 
though  the  outer  walls  into  the  sewer  and  trapped.  As  an 
additional  safeguard,  the  interior  pipe  system  is  also  inde- 
pendently ventilated.  The  sewers  are  so  constructed  as  to 
permit  of  convenient  inspection  at  certain  necessary  points. 
It  is  thought  objectionable  to  construct  flues  for  ventilating 
drains  or  sewers  in  the  walls  of  buildings.  Lavatories,  sinks, 
and  water-closets  arc  frequently  placed  in  projections  which 
are  entered  by  a  short  corridor  having  good  cross  ventila- 
tion. Supply  and  waste  pipes  are  of  large  size,  and  all  those 
within  the  building  are,  as  far  as  practicable,  exposed  to 
view.  In  some  instances  the  waste  from  the  baths  and  lava- 
tories is  discharged  into  automatic  flushing  tanks,  and  thus 
serves  the  purpose  of  flushing  the  sewers,  from  which  surface 
water  is  excluded.  Great  care  is  taken  to  have  sewers  and 
drains  laid  on  a  solid  bottom,  equally  graded  from  point  to 
point. 

For  greater  security  against  leakage  and  for  permanency, 
as  well  as  for  better  flushing  in  consequence  of  their  superior 
strength,  iron  pipes  are  coming  into  use  for  sewers  in  place 
of  glazed  earthen-ware.  Iron  pipes  arc  put  together  and 
secured  at  the  joints  with  lead  as  are  water-pipes,  and  when 
used,   will  answer  to  be  smaller  than  those  of    dazed  tile. 


BUILDINGS.  309 

It  is  customary  to  have  all  pipes  and  sewers  thoroughly- 
tested  before  covering  them  in.  Varnished  cast-iron  pipes 
are  mostly  used  for  water-mains,  none  of  them  being  less 
than  four  inches  in  diameter.  Wrought-iron  service  pipes 
are  now  commonly  used  in  place  of  lead  pipes  because  they 
are  cheaper  and  more  easily  fitted.  When  laid  under  ground, 
however,  they  are  incased  in  wood  and  protected  by  asphalt. 

In  many  of  the  foreign  asylums,  in  addition  to  bathing 
facilities  for  each  ward  or  group  of  patients,  there  is  pro- 
vided for  each  sex  a  general  bath-room,  adjoining  which  is 
a  pleasant  dressing-room  with  open  fire.  Bath-tubs  are  con- 
veniently placed  at  right-angles  to  the  wall  and  away  from 
it,  so  as  to  be  accessible  from  all  sides.  They  are  sometimes 
placed  in  curtained  stalls,  or  are  completely  secluded  by 
curtains  hung  on  rods.  The  floors  and  dados  of  bath-rooms, 
sculleries,  and  water-closets  are  generally  of  glazed  bricks  or 
tile,  and  on  the  floors  of  the  bath-rooms  is  usually  laid  some 
protection  for  the  feet.  Turkish  baths  are  not  uncommon, 
and  by  some  superintendents  are  thought  quite  beneficial  to 
a  certain  class  of  excited  and  sleepless  patients.  In  a  few 
instances  swimming  baths  similar  to  those  devised  by  Dr. 
A.  E.  Macdonald  of  Ward's  Island,  New  York  City,  are 
provided. 

Inquiry  was  made  at  every  place  visited  as  to  the  com- 
parative merits  of  plastered  and  unplastered  interior  walls. 
It  was  found  in  a  number  of  large  institutions  that  the 
walls  were  not  plastered,  but  painted  directly  upon  the 
brickwork.  The  opinion  of  experts,  especially  of  those  who 
had  tried  both  ways,  was  largely  in  favor  of  the  method  of 
plastering.  The  unplastered  walls  are  not  so  smooth,  are 
less  easily  kept  clean,  and  without  great  care  is  taken,  form 
a  harbor  for  vermin.  Besides,  to  lay  up  interior  walls  in  this 
way,  better  bricks  are  required,  and  more  time  is  taken  to 


3IO  RESUME. 

lay  them.  If  plastered  on  the  brick,  and  afterwards  painted 
or  coated  with  silicate,  the  walls  have  a  better  appearance, 
and  are  easily  washed.  When  a  building  is  completed,  little 
if  any  thing  has  been  saved  by  not  plastering. 

It  is  pleasant  to  note  the  prevalence  of  cheerful  open  fires 
in  the  day  and  sitting  rooms,  the  infirmary  wards,  and  also 
in  the  dormitories  of  English,  Scotch,  and  Irish  asylums. 
In  many  ordinary  wards  these  fires  are  without  guards  ; 
in  others  they  are  partially  protected,  while  in  the  refractory 
wards  they  are  generally,  but  not  invariably,  screened  by 
locked  fire-guards.  In  the  refractory  wards  at  Hanwell, 
those  in  use  were  not  locked.  So  far  as  I  could  learn,  there 
had  been  an  entire  immunity  from  accident.  Open  fires  are 
supplemented  by  some  other  method  of  increasing  the 
temperature  in  severe  weather,  usually  that  of  steam  or 
hot-water  heating. 

Outer  walls  are  frequently  built  with  a  hollow  space  be- 
tween the  bricks,  as  a  protection  against  dampness.  There 
are  also  flues  with  registers  near  the  floor  and  ceiling, 
which  may  be  opened  or  closed  as  occasion  requires. 
These  flues  connect  with  horizontal  air-ducts,  communicat- 
ing with  a  perpendicular  shaft  in  which  means  of  rarefaction 
are  placed.  In  some  places,  as  at  Berlin,  gas-jets  are  con- 
stantly burning  within  the  wall  flues,  to  facilitate  ventilation. 

The  elaborate  system  of  flues  with  great  air-passages  and 
enormous  fans  propelled  by  steam  power,  for  forcing  air  into 
the  various  apartments,  in  use  in  some  of  our  large  asylums, 
was  nowhere  seen,  either  in  Great  Britain  or  on  the  Continent. 
In  the  construction  of  asylum  buildings,  we  sometimes 
create  at  great  expense  a  highly  artificial  condition  which 
must  be  overcome  by  expensive  contrivances.  In  no  more 
important  particular  is  this  incongruity  manifest  than  in 
the   matter   of  ventilation.     It    would   seem  better   not  to 


BUILDINGS.  311 

depart  so  widely  from  natural  ways  of  living,  and  build  our 
asylums  more  as  we  build  our  homes. 

Thermometers  are  kept  in  the  various  rooms  and  corri- 
dors of  many  British  asylums,  and  the  temperature  is  re- 
corded at  stated  hours  during  the  day  and  night.  An 
incident  showing  the  desirability  of  this  regulation  occurred 
just  prior  to  my  visit  to  one  of  the  English  asylums.  The 
friends  of  one  of  the  patients  charged  that  much  suffer- 
ing had  been  caused  by  too  low  temperature  in  some  of 
the  rooms.  The  complaint  found  its  way  into  the  news- 
papers, and  much  feeling  was  aroused  against  the  asylum. 
The  management  obtained  the  appointment  of  a  committee 
composed  of  citizens  and  friends  of  the  patient,  to  investi- 
gate the  matter;  and  after  a  thorough  examination,  all 
were  perfectly  satisfied  that  the  system  disproved  the  charge. 

In  the  construction  of  foreign  asylums,  the  contingency 
of  fire  is  not  overlooked,  and  the  various  means  of  es- 
cape provided  appeared  to  be  sufficient.  For  protection 
against  fire,  British  asylums  have  alarm  signals,  night 
patrols,  the  regularity  of  whose  movements  are  recorded 
by  tell-tale  clocks,  electric  communication  with  alarm 
bells,  hydrants  conveniently  placed  on  the  different  floors, 
abundance  of  hose  ready  for  use,  also  a  plentiful  sup- 
ply of  buckets  filled  with  water.  The  keys  to  the  hy- 
drants are  close  at  hand,  often  locked  within  a  glass- 
covered  recess  in  the  wall.  By  this  arrangement  the 
inspector  can  see  whether  the  key  is  in  its  place  ;  and  it  is 
easily  accessible  in  case  of  emergency  by  breaking  the  glass. 
Some  of  the  institutions  have  fire-engines  with  the  usual 
appliances.  A  powerful  steam  force-pump  in  the  engine- 
house  connects  with  hydrants  in  every  department,  and  in 
many  asylums  there  is  a  fire  brigade  composed  of  employees, 
who  are  occasionally  called  out  and  trained.     The  attend- 


312  hAsumA. 

ants  in  each  section  are  particularly  instructed  in  precau- 
tionary measures  against  fire.  In  case  of  its  occurrence, 
they  are  charged  to  look  first  to  the  saving  of  life  and 
afterwards  to  the  preservation  of  property. 

FURNISHING    AND    DECORATION. 

That  nice  appreciation  of  comfort  which  is  a  characteristic 
of  the  English  people  is  noticeable  in  the  furnishing  of  their 
best  asylums.  It  is  seen  in  the  round-cornered  furniture, 
the  absence  of  angles  and  sharp  corners  in  jambs,  casings, 
etc.,  in  cushioned  and  easy  chairs  for  the  infirm,  the  not 
infrequent  use  of  carpets  to  deaden  sound,  and  many 
conveniences  elsewhere  described. 

It  can  be  said  of  the  asylums  of  Great  Britain  and  Ireland 
that  the  beds  are  very  comfortable.  The  bedding  usually 
includes  straw  and  hair  mattresses,  good  pillows,  and  an 
ample  supply  of  woollen  blankets.  For  the  refractory,  the 
sheets  are  of  very  heavy  linen  strongly  hemmed  to  prevent 
their  being  torn.  It  was  observed  that  woven-wire  mat- 
tresses were  coming  into  use  in  the  convalescent  wards  for 
quiet  and  orderly  patients.  It  is  important  that  the  wants 
of  the  insane  should  be  met  for  the  night  as  well  as  for  the 
day.  Failure  to  provide  them  with  good  beds  causes 
more  or  less  sleeplessness  and  unrest  during  the  hours 
allotted  to  repose,  which  results  in  disquiet  and  excitement 
the  following  day,  in  the  worry  of  the  attendants,  and  the 
disturbance  of  the  orderly  management  of  the  whole  asylum. 

Not  only  is  there  a  careful  regard  for  the  comfort  of  pa- 
tients, but  some  degree  of  elegance  is  seen  in  the  furnishing 
and  fitting  up  of  even  pauper  establishments  in  Great  Britain. 
The  vv'all  decorations  and  the  arrangement  of  artistic  objects 
designed  to  attract  attention  and  engage  the  mind  are 
exceedingly  praiseworthy.     The  interior  embellishments  at 


FURNISHING  AND  DECORATION.  313 

Prestwich,  Leavesden,  Caterham,  and  some  other  institu- 
tions for  pauper  patients  might,  perhaps,  be  the  subject  of 
criticism  were  it  not  that  the  beneficiaries  are  insane  per- 
sons for  whom  diversion  of  mind  is  necessary,  and  that 
these  pleasing  effects  are  produced  by  an  ingenious  and 
judicious  utiHzation   of  the   patients'  labor. 

Even  old  asylums  are  made  to  conform,  as  far  as  practica- 
ble, to  modern  ideas  respecting  an  abundance  of  sunlight 
and  cheerful  interiors.  There  is  no  doubt  but  that  many 
of  the  details  of  asylum  construction  and  furnishing  may 
be  made  to  exert  a  healing  and  otherwise  highly  beneficial 
influence  on  the  minds  of  the  mentally  diseased.  Respect- 
ing the  influence  of  bright  interiors  upon  the  insane,  Dr. 
Clouston  says  : 

"  If  persons  are  deprived  of  their  reason  and  personal 
liberty,  and  taken  away  from  their  homes,  too  much  can 
scarcely  be  done  for  their  comfort  and  happiness,  because 
nothing  can  possibly  make  up  to  them  for  what  their  disease 
has  necessarily  caused  them  to  be  deprived  of.  And  there 
is  in  most  cases  of  mental  disease  a  tendency  to  degeneration 
in  habits  and  ways,  which  it  should  be  one  of  the  most  unre- 
mitting efforts  of  any  good  asylum,  and  all  connected  with 
it,  to  counteract.  Nothing  rubs  off  the  veneer  of  good 
manners,  tidy  habits,  cleanly  ways,  and  all  the  little  ameni- 
ties and  considerations  for  others  that  mark  a  civilized  man, 
be  he  gentleman  or  not,  so  much  as  mental  disease.  Those 
who  come  in  daily  contact  with  the  insane,  seeing  these 
things  gone,  would  tend  insensibly  to  treat  them  as  if  they 
never  existed,  or  could  not  be  restored,  were  not  constant 
and  strenuous  efforts  made  to  fight  against  the  tendency. 
And  if  this  feeling  is  given  in  to,  it  reacts  on  the  attendant, 
and  causes  degeneration  in  him  too.  One  means  of  counter- 
acting   this    degeneration    is    undoubtedly    by    making  the 


314  RESUME. 

rooms  and  surroundings  scrupulously  clean  and  cheerful, 
the  painting  and  wall  papers  bright  and  elegant,  the  carpets 
(if  there  are  any)  tasteful,  and  the  clothing  as  good  as  the 
person  would  wear  outside.  If  it  is  clearly  seen  that  much 
thought  and  care  are  bestowed  on  these  matters,  down  to 
the  minutest  detail,  in  any  asylum  for  even  the  worst  class 
of  patients,  it  exercises  an  influence  on  them,  and  all  who 
have  to  do  with  them,  strongly  counteractive  of  the  lowering 
tendency  I  have  spoken  of.  It  greatly  helps  the  moral  and 
medical  treatment.  The  whole  spirit  of  the  institution 
should  be  philanthropic  and  medical,  not  mercenary,  prison- 
like, or  merely  disciplinarian." 

GROUNDS. 

The  grounds  of  foreign  asylums  are,  with  few  exceptions, 
elaborately  laid  out,  and  are  under  the  superintendence 
of  professional  resident  gardeners.  In  the  arrangement  of 
gravelled  walks,  a  proper  regard  for  the  happy  effects 
of  broad  green  lawns  is  usually  shown,  and  these  were 
seen  closely  mown  ;  while  the  walks  and  roadways  were 
kept  with  great  neatness.  By  means  of  propagating  houses 
and  by  the  removal  of  plants  from  the  conservatories  to 
the  corridors,  halls,  and  various  apartments,  and  to  the 
immediate  surroundings  of  the  asylums  in  summer,  the 
institutions  are  most  delightfully  brightened  and  beauti- 
fied. In  planting,  careful  judgment  is  exercised,  and  trees 
and  shrubbery  are  disposed  so  as  to  hide  that  which  is 
unsightly,  and  to  leave  openings  commanding  the  widest 
possible  prospect  of  that  which  is  pleasing.  It  was  ob- 
served that  walls  inclosing  yards  were  almost  invariably 
hidden  by  shrubbery  or  creepers.  In  some  places  the  haw- 
haw  is  used  instead  of  a  wall  where  it  is  undesirable  to 
obstruct  the  view.     The   improvement   of  the  grounds  and 


ORDERLY  ARRANGEMENT.  315 

keeping  them  in  high  condition  afterwards  is  mostly  the 
work  of  the  patients,  for  whom  it  proves  a  healthful  and 
agreeable  occupation.  The  vegetable  gardens  are  extensive, 
and,  through  careful  tillage  and  the  use  of  fertilizers  from 
the  asylum,  are  made  very  productive.  The  spade  is 
largely  used,  and  the  farming  is  generally  thorough  and 
yields  liberal  returns. 

In  building  an  asylum  much  will  be  saved  if,  at  the  outset, 
a  small  piece  of  land  is  set  apart  for  a  nursery.  By  the 
time  the  grounds  are  so  improved  as  to  be  ready  for  plant- 
ing, the  trees  and  shrubs  in  the  nursery  will  be  sufficiently 
matured  for  use,  and  thus  afford  a  cheap  and  abundant 
supply  of  plants  always  at  hand.  The  advantage  of  pursu- 
ing this  course  has  been  shown  in  the  description  of  Brook- 
wood  asylum,  where,  under  skilful  management,  the  sterile 
heath  was  soon  transformed  into  beautifully  ornamented 
grounds. 

ORDERLY    ARRANGEMENT. 

Great  particularity  is  observed  in  nearly  all  the  foreign 
asylums,  especially  in  those  of  the  British  Isles,  in  respect 
to  keeping  every  thing  in  its  proper  place.  The  store- 
rooms attract  attention  by  the  orderly  arrangement  of 
their  contents.  Supplies  are  withdrawn  from  them  only  by 
requisition,  and  the  books  there  are  kept  so  as  to  show 
the  stock  of  each  kind  of  goods  on  hand.  One  cannot  but 
admire  the  neatness  of  the  linen  closets,  the  tidy  appearance 
of  the  dormitories,  the  clean  aspect  of  the  kitchen,  the 
manner  of  putting  away  and  housing  tools  and  implements, 
and  the  care  with  which  rubbish  is  assorted  and  stored. 

It  was  frequently  found  that  broken  glass,  scrap  iron, 
lead,  etc.,  had  separate  locked  receptacles  of  deposit  into 
which  they  could  readily  be  put,  but  out  of  which  they 
could  not  be  taken  except  by  use  of  a  key.     What  is  often 


3l6  R^SUM^. 

regarded  as  waste  material  is  saved  and  in  one  way  or 
another  turned  to  profitable  account.  In  some  places  even 
the  bones  from  the  kitchen  are  pulverized,  then  dissolved 
and  used  for  fertilizing  the  ground.  Most  of  the  asylums 
have  a  walled  inclosure  for  depositing  unsightly  material 
only  occasionally  required  for  building  and  making  repairs. 
By  the  use  of  these  places  of  storage,  every  part  of  the 
grounds  is  made  to  present  an  orderly  appearance. 

SEWAGE. 

The  disposal  of  asylum  waste  was  a  subject  of  careful 
inquiry  at  every  place  visited.  In  the  continental  asylums, 
refuse  was  utilized  for  the  fertilization  of  the  soil  by  some 
of  the  various  processes  devised  for  this  purpose.  At 
several  institutions  liquid  manure  was  conveyed  to  the 
land,  while  solid  matter  was  converted  into  compost  by 
being  mixed  with  earth,  chalk,  and  other  substances.  A 
plan  highly  spoken  of  was  that  of  separating  the  solid  from 
the  liquid  by  means  of  a  series  of  vats  placed  at  different 
elevations  in  the  fields,  the  waste  being  emptied  into  the 
highest,  from  which  the  liquid  flows  successively  through 
the  rest  of  the  vats  until  entirely  separated  from  the  solid 
matter.  What  is  termed  the  bucket  system  is  common. 
The  tubs  or  cylinders  are  daily  withdrawn,  emptied,  and 
renovated.  Their  removal  is  effected  from  the  outside  of 
the  building.  In  Great  Britain  some  of  the  plans  adopted 
on  the  Continent  were  in  use,  as  also  other  methods 
more  expensive.  The  English  Commissioners  in  Lunacy 
recommend  that  sewage  be  distributed  in  a  fresh  state 
over  the  land,  by  gravitation  through  pipes,  or  by  tubular 
drainage.  Indoor  portable  earth-closets  were  used  to  a 
limited  extent,  and  in  some  institutions  had  been  rejected 
after  trial. 


GREATER  FREEDOM.  317 

Perhaps  on  no  other  subject  investigated  was  there  found 
a  greater  variety  of  conflicting  opinions  than  that  relating  to 
the  best  means  of  disposing  of  asylum  waste.  Situation 
sometimes  exercised  a  controlling  influence,  as  in  the  case  of 
an  asylum  located  adjacent  to  a  public  sewerage  system  ;  but 
where  this  method  of  disposal  was  not  available,  widely  dif- 
erent  plans  had  been  adopted,  some  of  them  quite  expensive, 
and  once  it  was  found  that  one  institution  was  introducing 
a  plan  just  discarded  by  another.  It  would  seem  that 
where  large  agricultural  operations  are  conducted  in  connec- 
tion with  asylums,  the  waste  should  be  used  to  keep  up  the 
fertility  of  the  soil  and  supply  what  is  lost  by  cropping,  as 
this  is  a  natural  process  of  compensation  invited  by  the  dis- 
infecting properties  of  fresh  earth. 

GREATER    FREEDOM. 

There  is  a  strong  tendency  in  the  better  class  of  institutions 
to  do  away  with  many  restrictions,  which,  at  one  time,  were 
deemed  absolutely  necessary  in  the  care  and  management  of 
the  insane.  Especially  is  this  noticeable  in  Scotland,  in  the 
abolishment  of  walled  airing-courts,  and  the  adoption  of 
what  is  termed  the  open-door  system.  In  some  of  the  Scot- 
tish asylums  one  may  walk  through  the  establishment  from 
one  end  to  the  other  without  unlocking  a  door.  The 
windows  on  the  first  floor  of  what  are  termed  "  open- 
door "  asylums,  are  not  barred  nor  grated.  They  have 
sashes  as  in  ordinary  dwellings,  and  may  be  opened  at  will. 
It  is  said  that  the  disuse  of  airing-courts  in  Scotland  first 
came  about  by  accident.  An  old  asylum  was  undergoing 
repairs,  and  it  became  necessary  to  take  down  the  walls  of 
one  of  its  airing-courts.  The  work  of  rebuilding  being 
temporarily  delayed,  it  was  found  meanwhile  that  it  was 
possible  to  conduct  the  administration  better  without  them 


3l8  RESUME. 

than  with  them,  and  the  cost  of  reconstruction  was  saved. 
It  having  been  demonstrated  that  these  prison-Hke  barriers 
were  both  unnecessary  and  injurious,  other  asylums  soon  set 
about  removing  their  enclosures. 

The  freer  system,  which  prevails  in  Scotland,  is  extending 
in  other  countries.  It  is  claimed  by  those  advocating  it, 
that  the  larger  liberty  given  the  patients  does  not  add  to 
the  attempts  to  escape  nor  to  the  number  of  suicides,  the 
tendency  to  self-destruction  being  thereby  diminished.  Dr. 
Joseph  Petit,  Superintendent  of  the  Sligo  District  Asylum, 
Ireland,  after  having  introduced  the  open-door  system  into 
the  institution  under  his  charge  and  having  tried  it  for 
several  years,  speaks  highly  of  its  tranquillizing  effect 
upon  the  patients,  and  regards  it  as  a  decided  improve- 
ment. Respecting  airing-courts,  which  he  has  abolished, 
he  says  : 

"Airing-courts  were  provided  to  guard  against  the  possi- 
bility of  escape  while  the  patients  took  exercise  in  the  open 
air.  In  District  Asylums  these  courts  are  usually  so  placed 
as  to  be  bounded  on  two  sides  by  the  buildings.  The 
atmosphere  in  them  can  hardly  be  called  open  air,  and 
with  regard  to  escapes,  experience  teaches,  as  might  be 
expected,  that  the  less  the  amount  of  restraint  the  fewer 
the  escapes.  Another  very  objectionable  feature  about 
airing-courts  is  the  bad  effect  they  have  upon  attendants, 
who  fall  into  the  error  of  supposing  that  when  the  patients 
are  put  within  the  walls  of  an  airing-court  they  require  no 
further  looking  after  on  the  attendants'  part.  Judged  from 
results,  I  think  it  will  be  admitted  that  money  spent  upon 
these  enclosures  is  not  only  uselessly  but  injuriously  ex- 
pended. This  last  remark  is  also  applicable  to  boundary 
walls,  except  where  the  grounds  adjoin  public  roads." 

So    satisfactory  has   the  absence  of  walled   airing-courts 


NON-RESTRAINT.  319 

proved,  that  there  is  no  probability  of  their  being  adjuncts 
to  future  asylums. 

NON-RESTRAINT. 

The  discarding  of  old  and  cruel  forms  of  restraint  has 
been  shown  to  be  conducive  to  the  recovery  of  the  curable 
and  to  the  comfort  and  happiness  of  the  incurable  insane. 
Freed  from  his  bonds,  with  opportunities  for  recreation  and 
employment,  the  patient,  who,  in  former  times,  would  have 
been  a  constant  source  of  anxiety  to  those  having  him  in 
charge,  is  now  tractable,  and  even  serviceable  in  lessening 
the  pecuniary  burden  consequent  upon  his  care.  To  main- 
tain the  system  which  produces  this  result,  however,  is  a 
work  that  taxes  all  the  ingenuity  and  resources  of  an  intelli- 
gent and  experienced  medical  staff  supported  by  well-trained 
attendants.  They  must  be  ever  vigilant  to  win  the  patient 
gradually  to  ways  of  gentleness  if  he  be  violent,  and  to  arouse 
his  energies  and  sympathies  if  he  be  melancholic. 

The  appliances  for  mechanical  restraint  were  not  found  in 
foreign  asylums  to  the  extent  expected.  The  crib  was  no- 
where seen,  and  my  inquiry  for  it,  in  some  instances,  was 
met  by  a  look  of  surprise.  Restraining  chairs  were  some- 
times observed,  but  muffs  and  gloves  were  only  occasionally 
seen  in  use,  and  it  was  said  that  when  they  were  put  on,  it 
was  usually  for  surgical  reasons.  Padded  rooms  for  the  seclu- 
sion of  maniacal  patients  were  found  in  many  of  the  British 
institutions.  These  are  thickly  cushioned  on  sections  of 
plank,  which  are  removable  for  purposes  of  renovation.  The 
floor  is  not  always  padded,  but  is  often  covered  with  rugs 
of  thick  matting,  as  at  Hanwell  and  Brookwood.  The  num- 
ber of  such  rooms,  always  few,  varies.  In  some  parts  they 
are  losing  favor.  It  was  generally  asserted  that  chemical 
had  not  taken  the  place  of  mechanical  restraint.     The  terms 


320  rAsume. 

non-restraint  and  seclusion,  however,  were  very  differently 
used,  and  I  found  at  times  that  greater  restrictions  were 
resorted  to  than  the  correct  meaning  of  these  words  would 
imply.  As  showing  what  some  of  the  English  asylum 
superintendents  mean  by  restraint,  attention  is  directed  to 
the  definition  given  by  Dr.  Brushfield,  late  of  Brookwood 
asylum,  in  the  notes  on  that  institution. 

From  my  observations  in  asylums  in  Great  Britain  and  in 
this  country,  I  should  say  that,  on  the  whole,  there  was  less 
restraint  there  than  here,  notwithstanding  the  fact  that  in 
many  asylums  in  the  United  States  it  may  be  said  to  be 
virtually  discarded.  There  can  be  no  question  but  that  the 
theory  of  non-restraint,  once  so  thoroughly  resisted,  is  now 
coming  to  be  universally  accepted  ;  and  the  extent  to  which 
it  has  been  adopted  in  recent  years  in  our  asylums  leads  to 
the  belief  that  the  time  is  not  far  distant  when  what  is 
commonly  understood  as  non-restraint  and  the  open-door 
system  will  be  put  in  practice  to  a  greater  extent  in  this 
country  than  it  now  is  in  Great  Britain  or  on  the  Continent. 

Some  who  approve  of  the  system  claim  that  under  it 
the  number  of  attendants  is  not  actually  or  necessarily  in- 
creased ;  others  favoring  it,  concede  that  there  must  be  a 
stronger  corps  of  attendants,  and  that  they  must  exercise 
greater  watchfulness,  but  confidently  assert  that  the  benefits 
arising  to  the  patient  more  than  counterbalance  the  dif^- 
culties  attending  the  carrying  out  of  the  freer  system.  It  is 
claimed  further  that  a  quieter  and  more  orderly  administra- 
tion is  the  result ;  that  there  is  less  destruction  of  property; 
that  more  patients  are  employed,  and  consequently  there 
are  larger  industrial  products. 

In  many  of  the  British  asylums  it  is  the- rule  that,  in  case 
it  becomes  necessary  to  use  personal  force  to  remove  a  pa- 
tient, a  sufificient   number  of  attendants  shall  be  called  in  to 


MEDICAL   OFFICERS.  32  I 

accomplish  the  object  without  having  a  doubtful  struggle. 
The  fact  thus  made  apparent,  that  opposition  would  be  use- 
less, frequently  causes  the  patient  to  make  no  resistance 
whatever,  and  the  desired  change  is  effected  without  dis- 
turbance. An  acute  case,  when  violent  and  excited,  is 
placed  in  exclusive  charge  of  two  experienced  attendants, 
who  give  the  patient  several  hours'  daily  exercise  in  the 
open  air  and  watch  him  carefully  in  the  wards  until  his 
excitement  subsides  and  one  person  can  assume  the  care 
of  him.  Finally,  the  other  special  attendant  is  relieved, 
and  the  case  receives  ordinary  attention.  The  late  Chair- 
man of  the  English  Lunacy  Board  in  speaking  of  this 
method,  said  : 

"  It  requires  a  greater  number  of  keepers,  or  rather  attend- 
ants, and  it  requires  men  of  a  very  different  character, — men 
of  great  forbearance  and  patience,  men  of  great  power  of 
endurance  ;  for  there  is  nothing  on  the  face  of  the  earth  one 
half  so  provoking  as  a  madman  when  he  chooses  to  be  so. 
I  have  looked  in  perfect  astonishment  at  the  character 
exhibited  by  the  attendants  in  forbearance  and  moderation, 
and  at  what  they  patiently  go  through.  To  control  a  vio- 
lent patient  it  requires  three  or  four  attendants.  Formerly 
they  would  have  put  him  in  leg-locks  and  left  him.  The  man 
would  have  become  ten  times  worse,  and  the  whole  place 
would  have  been  in  disorder,  because  although  you  chained 
a  man  you  could  not  stop  his  voice,  and  he  roared  and  bel- 
lowed in  such  a  way  as  few  outside  people  can  imagine." 

MEDICAL    OFFICERS. 

The  medical  staff  in  foreign  asylums  is  not  so  large  as  in 
similar  institutions  in  the  United  States,  and  in  some  of 
them  the  number  of  physicians  appeared  to  be  inadequate. 
It   was  not  found    in   any   of  the   asylums   visited   that    to 


322  R&SUMA. 

female  patients  were  accorded  the  medical  services  of  physi- 
cians of  their  own  sex,  as  is  the  growing  and  commendable 
practice  in  this  country.  The  experiment,  if  such  it  may  be 
called,  of  having  two  head  officers  to  one  institution,  as  was 
twice  observed  during  my  tour  of  inspection,  has  not  worked 
satisfactorily  in  the  opinion  of  those  competent  to  judge, 
although  no  complaint  was  made  by  those  in  charge. 

ATTENDANTS. 

The  success  of  asylum  management  is  without  doubt 
largely  dependent  on  the  maintaining  of  a  good  corps  of 
intelligent  and  faithful  attendants.  One  who  has  justly 
achieved  distinction  in  the  treatment  of  the  insane  says :  "  The 
longer  I  live,  the  more  clear  it  is  to  me  that  good  attendants, 
well  trained,  interested  in  their  work,  and  proud  of  their 
success  in  it,  with  good  heads  on  their  shoulders,  humane 
dispositions,  pleasant  manners,  and  ever  using  the  brains 
they  have  to  do  their  work,  must  be  the  sheet-anchor  of 
success  in  an  hospital  for  the  treatment  of  mental  disease." 

An  attendant  who  does  not  look  upon  a  person  mentally 
diseased  with  the  same  sympathy  as  he  looks  upon  one  bodily 
sick  has  a  wrong  conception  of  his  relations  to  the  patient, 
and  is  likely  to  be  cruel  when  meaning  only  to  be  just.  It 
should  never  be  overlooked  by  those  in  charge  of  the  insane 
that  they  are  not  responsible  for  their  acts,  and  may  be 
entirely  unconscious  of  what  they  are  doing.  Failing  to 
realize  this,  abusive  language  and  personal  indignities 
directed  to  the  attendant  awaken  his  resentment  and  a 
desire  to  discipline  the  patient.  Hatred  is  thus  inspired? 
and  a  permanent  barrier  is  created  between  them.  If  the 
attendant  would  keep  in  mind  the  golden  rule — -Do  unto 
others  as  ye  would  that  they  should  do  unto  you — and  im- 
agine himself  in  the  patient's  place,  and  how  he  would  like 


ATTENDANTS.  323 

to  be  treated  if  similarly  situated,  much  cruelty  would  be 
avoided  and  more  of  the  insane  would  recover.  The  law  of 
kindness  is  universal,  and  is  as  applicable  in  the  treatment 
of  the  insane  as  in  the  treatment  of  any  other  of  the  help- 
less classes,  and  should  be  the  guiding  principle  in  their 
care.  Though  its  influence  may  not  be  immediately  per- 
ceptible, its  subtle  power  gradually  wins  its  way — producing 
quietness  where  there  was  violence  and  disturbance — and 
develops  self-control  in  both  attendant  and  patient. 

As  great  suffering  may  result  to  the  insane  from  neglect 
as  from  intentional  cruelty  or  systematic  severity.  It  is 
much  easier  to  seclude  or  confine  a  man  when  restless  or 
violent  than  it  is  to  make  some  effort  to  employ  him  or 
divert  his  thoughts  from  real  or  imaginary  troubles. 
Separated  from  the  world  as  he  is,  it  rests  with  the 
attendant  to  soothe  and  comfort  ;  or,  through  indifference, 
incompetency,  or  acts  of  petty  tyranny,  to  exasperate,  and 
make  the  daily  life  of  a  patient  unendurable,  thus  deepening 
the  dark  shadows  that  have  gathered  around  his  clouded 
reason. 

Much  has  been  accomplished  in  rescuing  the  insane  from 
chains,  gloomy  cells,  and  scourgings  ;  but  the  measure  of 
reform  in  their  behalf  will  not  be  complete  until  there  is 
no  possibility  of  their  being  subjected  to  the  humors  of 
ignorant,  unfeeling,  and  incompetent  attendants. 

The  need  of  persons  systematically  trained  to  properly 
discharge  the  duties  of  attendants  is  felt  in  Great  Britain 
and  on  the  Continent  ;  but  the  effort  to  provide  such 
by  affording  preliminary  instruction  does  not  appear 
to  be  so  general  as  in  the  United  States.  In  connection 
with  a  hospital  for  female  patients  at  IMorningside,  there 
has  been  established  a  probationary  ward  and  training- 
school  for  all  the  new-coming  female  attendants.     Here  they 


324  RESUME. 

are  taught  to  regard  their  patients  as  they  would  those  of  an 
ordinary  hospital,  and  they  enter  upon  their  duties  by  learn- 
ing to  nurse  the  sick.  Dr.  Clouston  says :  "  If  any  thing 
will  produce  a  habit  of  kindness,  this  will  be  likely  to  do 
so."  The  plan  of  training  at  Morningside  has  proved  of 
great  advantage.  In  England,  Dr.  Wallis,  of  Whittingham, 
has  instituted  a  system  of  training  for  attendants  and 
nurses,  and  some  other  foreign  asylums  have  entered  upon 
the  same  undertaking. 

In  view  of  the  large  numbers  to  be  employed  and  the  pe- 
culiarities of  the  difificult  service,  the  question  of  how  the 
evil  of  incompetent  attendants  is  to  be  reduced  to  the  mini- 
mum is  an  important  one.  A  partial  solution  will  no  doubt 
be  found  in  the  establishment  of  training-schools.  By  af- 
fording through  these  preliminary  instruction,  great  advan- 
tage will  be  gained.  Dr.  Stephen  Smith,  the  New-York 
State  Commissioner  in  Lunacy,  through  whose  earnest 
advocacy  several  training-schools  for  attendants  have  been 
established  in  the  asylums  under  his  supervision,  says 
that  where  introduced  there  has  been  an  improvement  in 
the  order  and  discipline ;  that  patients  are  treated  with 
more  consideration  ;  the  sick  are  better  cared  for,  self- 
reliance  cultivated,  emergencies  more  successfully  met,  the 
power  of  observation  on  the  part  of  attendants  quickened, 
and  changes  in  both  the  mental  and  physical  condition  of 
patients  more  readily  appreciated.  The  first  training-school  in 
the  State  of  New  York  was  organized  by  Dr.  J.  B.  Andrews, 
Superintendent  of  the  Buffalo  State  Asylum,  and  has  proved 
eminently  successful. 

The  object  of  the  training-school  being  to  prepare  per- 
sons for  competent  attendants,  those  who  have  not  the 
natural  ability  and  cannot  acquire  fitness  by  education  are 
of  course  weeded  out.     These  schools  should  be  so  organ- 


A  TTENDANTS.  325 

ized  that  certificates  of  graduation  would  be  pretty  sure 
evidence  of  the  competency  of  those  receiving  them  for 
the  proper  discharge  of  their  duties.  While  the  training 
should  be  both  practical  and  theoretical,  the  instruction 
should  not  be  so  technical  or  difificult  that  the  merely 
intellectual  student  would  be  advanced  beyond  those  special- 
ly adapted  by  nature  for  their  peculiar  work. 

It  is  gratifying  to  note  that  wherever  opportunities  have 
been  afforded  by  the  State  in  its  training-schools  for  acquir- 
ing that  knowledge  so  necessary  in  the  care  of  the  insane,  a 
laudable  desire  has  been  shown  on  the  part  of  attendants 
to  increase  their  capacity  for  usefulness  by  the  means  thus 
provided. 

The  wages  paid  should  be  sufficient  to  induce  those  pos- 
sessing more  than  average  ability  to  enter  the  service. 
The  plan  adopted  in  England  of  yearly  increasing  the  com- 
pensation of  attendants  till  the  maximum  salary  is  reached 
stimulates  them  to  faithful  endeavor.  The  expectation 
that  through  servang  long  and  satisfactorily,  a  government 
pension  may  be  secured,  is  another  incentive  to  a  proper 
discharge  of  duty.  The  granting  of  pensions  to  superan- 
nuated officers  and  servants  is  permissible  by  the  statute, 
in  the  county  and  borough  asylums  of  England,  the  char- 
tered asylums  in  Scotland,  and  the  district  asylums  in  Ireland. 

Such  persons  should  be  employed  as  intend  to  make 
the  care  of  the  insane  a  permanent  occupation.  They 
should  be  selected  from  those  who  have  attained  mature 
judgment,  but  have  not  passed  the  prime  of  mental  and 
physical  vigor  ;  they  should  have  good  health  and  cheerful 
and  equable  tempers  ;  they  should  possess  self-control,  and 
be  able  to  furnish  proof  of  good  moral  character. 

To  further  perfect  and  purify  the  service,  the  cause  for 
leaving  an   asylum   should   be  reported,  in  every  case,  to  a 


326  RESUME. 

central  authority  and  made  a  matter  of  record,  and  no 
attendant  should  be  employed  without  reference  to  the 
record.  This  practice  obtains  in  England,  where  a  regis- 
ter is  kept  by  the  Lunacy  Commissioners  of  all  discharged 
employees,  and  the  cause  of  their  discharge.  In  this  coun- 
try such  a  system  could  be  made  more  valuable  by  co-opera- 
tion among  the  different  States. 

The  great  strain  to  which  faithful  asylum  attendants  are 
subjected  when  on  duty,  makes  it  but  just  that  they  should 
have  reasonable  opportunities  for  relaxation  and  recreation 
when  off  duty,  and  that  their  accommodations  and  surround- 
ings should  be  made  pleasant.  Their  cheerful  spirits,  which 
are  reflected  upon  those  under  their  charge,  should  be 
fully  sustained.  Such  arrangements  would  induce  more  of 
those  best  adapted  for  the  service  to  enter  it.  This  ap- 
pears to  be  the  view  taken  by  the  superintendent  of  one  of 
the  large  asylums  in  England,  where,  as  in  this  country, 
there  is  difficulty  in  securing  and  keeping  qualified  attend- 
ants.    Bearing  upon  this  subject,  Dr.  Ley  of  Prestwich  says: 

"  The  great  problem  in  asylum  management  is,  how  to 
obtain  good  attendants  ;  and  when  obtained,  how  to  retain 
their  services.  In  every  asylum  this  difficulty,  in  a  greater 
or  less  degree,  has  been  felt,  and  in  an  institution  of  this 
magnitude,  where  obviously  a  greater  proportion  of  experi- 
enced attendants  is  required,  the  difficulty  in  procuring  and 
maintaining  a  staff  of  trustworthy  subordinates  has  become 
a  source  of  never-ending  trouble  and  anxiety.  No  one  con- 
versant with  the  working  of  an  asylum  can  doubt  that  much 
of  the  success  of  management,  economical  and  otherwise,  is 
dependent  upon  the  character  and  reliability  of  the  attend- 
ants, who  are  necessarily  entrusted  with  the  immediate  care 
of  the  patients.  The  comfort,  the  safety,  even  the  lives  of 
those  under  their  charge,  depend   upon  the  good  conduct. 


NIGHT  SERVICE.  327 

fidelity,  and  watchfulness  of  these  ofificials,  who  are,  in  point 
of  fact,  the  instruments  by  which  all  the  details  of  moral 
treatment  are  brought  into  practice.  The  service  is  an 
arduous  one,  and  those  who  take  to  it  are  generally  persons 
devoid  of  all  training;  consequently  of  the  many  who  apply 
only  a  few  are  found  gifted  with  the  necessary  qualities  of 
temper  and  judgment,  without  which  no  good  attendant  can 
be  made.  ...  I  think  there  can  be  no  doubt  that,  apart 
from  the  question  of  salaries,  much  of  the  restlessness  that 
affects  the  asylum  attendant  of  the  present  day  is  due  to 
the  fact  that  his  position  is  considered  an  inferior  one,  be- 
cause the  accommodation  provided  and  the  arrangements 
made  for  his  comfort  and  relaxation  are  not  equal  to  what 
persons  in  the  same  calling  are  able  to  obtain  in  other 
branches  of  the  public  service.  In  all  the  principal  General 
Hospitals  and  Infirmaries  it  has  been  found  necessary,  in 
order  to  attract  applicants  of  the  requisite  character  and 
intelligence,  to  deal  liberally  with  their  nursing  staff.  Sep- 
arate accommodation  has  been  provided,  and  the  comfort 
and  convenience  of  the  daily  lives  of  these  officials  have 
been  considered  in  every  reasonable  way.  The  result  has 
been  that  the  service  is  an  attractive  one,  and  hospitals  and 
infirmaries  have  become  serious  competitors  with  asylums  in 
the  female  labor  market.  I  think  it  reasonable  to  expect 
that  equal  consideration  for  the  comfort  and  accommoda- 
tion of  the  attendants  would  be  equally  successful  in  render- 
ing asylum  service  popular  with  candidates  of  character  and 
ability,  to  whom  the  retention  of  their  situation  would  be 
an  object  of  some  consequence." 

NIGHT    SERVICE. 

The  night  supervision  of  some  of  the  English  asylums  is 
very  complete.       The    night    staff    is    under    a    chief,    and 


328  RESUME. 

outdoor  and  indoor  patrols  are  provided.  Epileptic  patients 
in  their  separate  wards,  as  also  the  suicidal,  are  the  objects 
of  special  and  constant  watchfulness.  In  some  cases  the 
attendants  occupy  a  raised  platform  commanding  a  view  of 
all  those  under  their  care.  The  beds  for  epileptics  are 
ordinarily  but  a  few  inches  from  the  floor.  In  the  wards 
for  the  filthy  particular  attention  is  paid  to  the  inmates, 
and  the  bedding  is  changed  and  the  bath  resorted  to  as 
occasion  requires.  In  some  of  the  foreign  asylums,  especially 
the  French,  a  strict  rule  is  enforced  requiring  every  patient 
to  observe  a  regular  habit  before  retiring.  Each  attendant 
makes  his  report  to  the  medical  officer  every  morning  and 
delivers  his  patients  in  a  neat  and  satisfactory  condition 
to  the  care  of  the  day  officer.  The  dormitories  are  warmed 
through  the  night  by  open  fires,  which  aid  in  purifying  the 
atmosphere.  By  means  of  electric  communication  assistance 
may  be  summoned  in  case  of  an  emergency.  The  night- 
watch  is  checked  by  tell-tale  clocks. 

RELIGIOUS    EXERCISES. 

A  place  for  divine  worship  is  found  in  connection  with  all 
public  asylums  in  the  British  Isles.  Although  a  hall  is 
commonly  provided  for  this  purpose,  sometimes  there  is  a 
separate  church  edifice  quite  expensively  built,  with  much 
attention  given  to  architectural  details.  It  is  customary  for 
men  and  women  patients  to  enter  from  opposite  sides  and 
sit  apart.  A  chaplain  regularly  officiates,  and  the  attend- 
ance upon  the  service  in  some  asylums  is  quite  large. 
Arrangements  are  usually  made  for  conducting  both 
Protestant  and  Roman  Catholic  services,  and  at  some  places 
a  Jewish  Rabbi  also  officiates.  It  was  generally  thought 
that  affording  such  of  the  insane  as  could  properly  attend 
divine    worship    an    opportunity    to    do    so,  was   only  con- 


AMUSEMENTS.  329 

ceding  to  them  a  just  privilege,   and   that  the  effect  was 
salutary. 

AMUSEMENTS. 

The  treatment  of  the  insane  in  some  of  the  leading 
asylums  of  Europe  appears  to  be  in  accordance  with  the 
views  of  Dr.  ConoUy,  who  endeavored  "  to  remove  all  causes 
of  irritation  and  excitement  from  the  irritable ;  to  soothe, 
encourage,  and  comfort  the  depressed  ;  to  repress  the  violent 
by  methods  which  leave  no  painful  recollections,  and  in  all 
cases  to  seize  any  opportunity  of  promoting  the  restoration 
of  the  healthy  exercise  of  the  understanding  and  of  the 
affections."  In  the  application  of  these  principles,  every 
variety  of  entertainment  that  can  divert  the  mind  or  excite 
pleasurable  emotions  is  brought  into  requisition. 

A  spacious,  cheerfully  decorated,  and  pleasant  amusement 
hall,  usually  on  the  ground-floor,  is  considered  indispen- 
sable in  British  asylums.  A  band,  generally  made  up 
of  asylum  attendants,  plays,  at  seasonable  times,  for 
the  amusement  of  the  patients.  Besides  concerts,  dances, 
and  other  entertainments,  there  are  cricket  clubs,  ball  play- 
ing, etc.  In  some  institutions  an  occasional  costume  ball  is 
given,  in  the  long  preparation  for  which  the  minds  of  the 
patients  are  diverted.  Their  tastes  in  dress  are  gratified  as  far 
as  possible.  In  these  festivities  benevolent  persons  residing 
neai  the  asylum  are  encouraged  to  participate.  Theatricals 
on  an  elaborate  scale  are  also  gotten  up,  from  which  those 
who  attend  derive  much  enjoyment. 

Respecting  dancing  as  a  means  of  entertainment,  the  late 
Dr.  Eames  of  the  Cork  District  Lunatic  Asylum  said  : 

"  Most  essential  of  all  amusements,  I  think,  are  the  even- 
ing dances,  which  are  held  here  regularly  four  nights  weekly. 
All  the  patients  look  forward  with  pleasure  when  the  day  is 
over  to  these  two  hours  of  amusement  in  the  recreation  hall. 


330  RESUME, 

I  was  always  of  opinion  that  if  this  was  beneficial  to  patients 
one  night  weekly,  it  was  four  times  more  so  on  four  nights. 
On  the  evenings  when  there  is  no  dancing,  it  is  impossible 
to  prevent  the  attendants  allowing  patients  to  retire  to  bed 
soon  after  supper ;  there  is  nothing  for  either  to  do,  and  time 
becomes  irksome  to  both.  When  the  patients  go  to  bed  at 
this  early  hour,  they  cannot  sleep,  and  thus  their  night's  rest 
is  spoiled.  On  this  account  I  have  always  insisted  upon  two 
hours  being  spent  in  the  recreation  hall  on  at  least  four  nights* 
in  the  week.     Five  hundred  patients  generally  attend." 

It  may  be  questioned  whether  evening  dancing  and  music 
are  desirable  so  frequently  as  recommended  by  Dr.  Eames, 
but  numerous  authorities  favor  some  kind  of  entertainment 
on  the  evening  of  every  secular  day,  in  order  to  break  the 
tedious  monotony  occurring  between  supper  and  bed-time. 

At  Morningside  a  special  endeavor  is  made  to  afford 
the  insane  every  possible  advantage  that  can  be  derived 
from  frequent  and  varied  amusements  and  entertainments. 
Dr.  Clouston  says : 

"  The  treatment  of  mental  disease  is  in  many  cases  a  fight 
against  morbid  unsocial  ways,  degrading  tendencies,  and  idle, 
selfish,  listless,  uninterested  habits  of  mind  ;  and  we  fight 
those  by  moral  means,  by  employment,  amusement,  good 
food,  fresh  air,  exercise,  and  good  hygienic  conditions  of  life. 

"Amusements  are,  no  doubt,  of  the  greatest  service  in  the 
treatment  with  a  view  to  the  recovery  of  insane  patients. 
They  arc  next  to  and  supplementary  to  good  food,  cheerful 
quarters,  kind  treatment,  medical  care,  and  suitable  employ- 
ment. No  one  can  be  present  at  one  of  our  dances  without 
being  impressed  by  seeing  how  a  happy,  cheerful  state  of 
mind  takes  the  place  of  gloom  in  some  patients  through  this 
amusement.  They  act  on  insane  people  somewhat  in  the 
way  they  do  on  sane  people,  but  the  effect  is  more  marked 


AMUSEMENTS.  33 1 

from  the  sharp  contrast  between  the  insanity  of  expression 
and  attitude  before  the  dance  and  the  sanity  (so  far  as 
it  goes  and  so  long  as  it  lasts)  during  the  exercise.  We  have  to 
provide  a  great  variety  of  amusements  to  suit  different 
tastes.  No  one  should  continue  long  enough  or  recur  often 
enough  to  produce  satiety.  Different  patients  are  amusable 
in  very  different  ways  and  degrees  too,  just  as  different  sane 
people  are.  There  are  many  patients  in  such  a  morbid 
brain-condition,  that  they  can  scarcely  be  amused  or  inter- 
ested in  any  thing,  but  those  are  the  minority.  Some  of  the 
patients  get  re-interested  in  the  amusements  to  which  they 
have  been  accustomed  in  their  former  lives;  others  are  taken 
with  new  diversions.  We  train  people  to  dance  here  who 
never  danced  before;  to  play  billiards,  bowls,  cricket,  tennis, 
curling,  cards,  dominoes,  and  draughts  who  had  never  played 
these  games  in  their  sane  lives.  I  have  known  many  cases 
where  the  interest  in  a  game  led  directly  to  recovery. 

"  Most  insane  people,  it  must  be  admitted,  do  not  rise  to 
the  enthusiasm  which  some  games  excite  in  ordinary  people. 
The  sanest  looking  people  on  our  curling  pond  during  an 
exciting  game  are  not  some  of  the  officials.  But  that 
prince  of  all  Scotch  games  has  the  power  to  rouse  the 
dormant  seeds  of  sane  enthusiasm  for  the  time  in  some  of 
our  patients  in  a  wonderful  way.  An  old  curler  seldom  gets 
so  insane  that  its  enthusiasm  and  its  familiar  terms  don't 
come  back  to  him  when  he  finds  himself  on  the  ice.  This 
year  (1885)  we  had  a  very  exciting  struggle  for  the  silver 
medal,  which  Dr.  Batty  Tuke,  an  old  assistant  physician 
here,  most  thoughtfully  presented  to  our  club.  It  was  felt 
by  all  that  day  that  the  best  curler  was  the  best  man,  quite 
irrespective  of  his  social  or  mental  condition.  The  day  was 
fine,  the  ice  good,  the  pond  was  surrounded  with  crowds  of 
interested  onlookers,  and  some  of  the  ladies  stimulated  the 


332  RESUME. 

players  by  the  very  outspoken  expressions  of  their  hopes  as 
to  whom  they  would  like  to  see  successful.  One  man,  a 
keen  and  fine  old  curler,  had  been  for  some  time  in  a  dull 
humor.  He  curled  in  a  dogged  but  apparently  uninter- 
ested, unenthusiastic  way,  not  speaking  to  any  one.  Towards 
the  finish  his  score  ran  up  fast,  and  he  did  begin  to  look 
a  little  more  lively  ;  but  when  with  his  last  stone  he 
*  chappit '  the  winner,  and  so  beat  the  man  by  one  point, 
who  had  been  running  him  neck  and  neck,  the  old  curler's 
spirit  triumphed  over  the  insanity,  a  sudden  change  came 
over  him,  and  he  became  '  another  man,'  throwing  his 
'besom'  into  the  air,  curler's  fashion.  His  whole  expres- 
sion and  attitude  changed,  as  he  received  the  congratulations 
of  his  friends  with  smiles,  and  made  an  eloquent  and  appro- 
priate speech  on  getting  the  medal.  I  could  not  help  think- 
ing that  if  I  had  some  medicine  in  the  surgery  which  would 
take  hold  of  my  patients'  brains,  as  curling  had  done  in  this 
case,  our  recovery-rate  would  be  a  larger  one." 

EMPLOYMENT. 

Many  foreign  alienists  lay  much  stress  on  the  efficacy  of 
wisely  directed  labor  in  producing  a  tranquillizing  influence 
upon  cases  that  seem  amenable  to  no  other  kind  of  treat- 
ment. Notable  illustrations  of  the  beneficial  effects  of  laun- 
dry and  farm  work  have  been  set  forth  in  the  descriptions  of 
Alt-Scherbitz,  Clermont,  and  Woodilee.  At  the  last-named 
institution  from  seventy-five  to  eighty  per  cent  of  the  in- 
mates are  said  to  be  employed  usefully  and  profitably.  Here 
the  presence  of  skilled  artisans  and  experienced  farmers  and 
gardeners,  not  only  directing,  but  working  with  the  insane, 
has  been  productive  of  excellent  results. 

The  most  acceptable  and  healthful  occupations  being 
those  of  gardening  and    farming,  the   English  and   Scotch 


EMPLOYMENT.  333 

have  an  advantage  over  us,  in  a  climate  where  it  is  possible 
to  send  their  patients  out-of-doors  to  work  or  take  recrea- 
tion during  the  greater  part  of  the  year.  In  Scotland  the 
benefits  of  agricultural  employment  appeared  to  be  more 
highly  appreciated  than  in  England,  nearly  all  the  men 
capable  of  so  doing  working  out-of-doors;  while  in  England 
they  were  frequently  seen  in  pleasant  weather  engaged  at 
indoor  work,  such  as  ward  cleaning,  bed  making,  etc.  The 
time  daily  devoted  to  outdoor  labor  at  Woodilee  was  from 
one  and  a  half  to  two  hours  longer  than  in  some  of  the  asy- 
lums near  London.  It  was  the  common  opinion  that  abun- 
dance of  outdoor  recreation  and  employment  was  the  secret 
of  tranquil  nights  and  contentment,  which  lead  to  recovery. 

A  variety  of  employment  should  be  provided,  so  that 
patients  can  be  placed  at  work  congenial  to  them.  Dr. 
Williams,  of  Haywards  Heath,  advocates  in  certain  cases  a 
change  from  the  occupation  to  which  the  patient  has  been 
accustomed  to  one  with  which  he  is  unfamiliar.  He  says  : 
^'  A  townbred  artisan,  such  as  a  tailor,  admitted  in  a  low 
state  of  bodily  health,  if  sent  out  daily  for  a  little  gentle 
employment  in  the  garden,  generally  becomes  greatly  im- 
proved physically,  and  concurrent  with  the  physical  im- 
provement often  comes  gradual  restoration  to  reason.  So 
also  a  rustic,  tending  towards  dementia,  if  put  to  work  at  a 
trade,  often  brightens  up  considerably  ;  whereas,  if  sent  out 
to  work  on  the  farm  or  in  the  garden,  employment  that 
he  had  been  used  to  from  birth,  would  set  to  work  at  it 
and  perform  it  mechanically,  and  it  would  be  of  but  little 
benefit   to  him." 

The  laundries,  in  which  large  numbers  of  the  insane  in 
foreign  asylums  are  employed,  are  conveniently  arranged, 
and  have  goodly  sized  rooms  for  assorting,  mending,  and  fold- 
ing clothes.     Although  there  is  usually  sufBcient  machinery 


334  RESUME. 

for  washing,  there  seems  to  be  a  growing  tendency  to 
do  more  of  the  work  by  hand,  in  order  to  make  avail- 
able a  means  by  which  excitable  patients  may  work  off 
their  superfluous  nervous  energies.  For  a  certain  class  of 
female  patients  hand  washing  has  been  found  to  be  the  best 
of  all  employments,  and  may  be  used  to  a  large  extent  as 
a  substitute  for  seclusion  and  restraint.  In  one  asylum  an 
entire  plant  of  washing  machinery  had  been  set  aside  and 
hand  washing  substituted  for  remedial  reasons.  It  may  be 
well  to  consider  whether  this  course  might  not  be  pursued 
with  advantage  in  other  asylums  where  machinery  is  used. 
The  experience  of  those  institutions  in  which  the  wash- 
ing is  done  by  hand  seems  to  warrant  such  a  course. 
In  the  abstract,  washing  by  machinery  is  cheaper  than  by 
hand,.but  when  the  number  of  attendants  that  may  be  dis- 
pensed with  in  the  refractory  wards  of  an  asylum  having  a 
large  laundry  operated  by  hand  is  considered,  it  is  claimed 
by  some  that  the  last-named  method  is  cheaper. 

The  English  Commissioners  in  Lunacy  lay  great  stress 
upon  the  desirability  of  providing  occupation  for  the  insane. 
They  say  :  "  In  the  treatment  of  the  insane  great  importance 
should  be  attached  to  the  subject  of  their  useful  employ- 
ment. Our  aim  constantly  is  to  encourage  the  efforts  of 
superintendents  to  devise  suitable  occupations,  and  to  induce 
their  patients  to  engage  in  them;  and  with  the  view  of  ascer- 
taining as  nearly  as  we  can  the  extent  to  which  such  efforts 
have  been  successful,  we  have  instituted  a  comparison  of  the 
results  attained  in  the  years  1877  and  1886  respectively."  The 
Commissioners  found  that  fifty-seven  per  cent  of  the  patients 
in  the  county  and  borough  asylums  were  employed  in  1877 
and  sixty-two  per  cent  in  1886.  In  some  English  asylums  the 
proportion  employed  during  the  latter  year  was  as  low  as  forty- 
five  per  cent  and  in  others  as  high  as  seventy-eight  per  cent. 


EMPL  O  YMEN  T.  335 

The  custom  of  inducing  patients  to  engage  in  useful  em- 
ployment is  extending  to  hospitals  and  licensed  houses,  and 
the  efforts  made  in  this  direction  are  encouraging.  At  St. 
Andrew's  Hospital  in  Northampton,  out  of  160  gentlemen 
at  one  time  in  the  institution,  56  were  occupied  in  the 
summer  at  farming  and  gardening,  while  18  worked  at 
carpentry,  printing,  etc.  Respecting  the  beneficial  effects 
of  outdoor  employment,  Dr.  Lloyd  Francis,  who  is  con- 
nected, with  this  institution,  says: 

"  Outdoor  labor  is  looked  upon  as  a  therapeutic  means  of 
the  highest  possible  value,  and  each  year  adds  fresh  evidence 
of  its  efificiency.  It  is  put  to  trialin  one  stage  or  another  of 
every  case  where  physical  disease  or  extreme  exhaustion  do 
not  contra-indicate.  The  means  of  persuasion  are  necessarily 
more  limited  than  in  a  county  asylum  ;  the  bait  of  certain 
privileges  and  small  extra  luxuries — ale,  tobacco,  and  the 
Hke,^so  tempting  to  the  pauper,  cannot  lure  the  private 
patient,  whose  diet  is  ample  and  varied,  and  whose  material 
comforts  no  amount  of  industry  can  increase.  There  re- 
mains, then,  only  argument,  moral  suasion  ;  and  hence 
oftentimes  much  difficulty  in  overcoming  the  irrational 
scruples,  more  especially  of  young  men.  The  idea  of  dig- 
ging, road-making,  or  wheeling  a  barrow  is,  even  in  the 
guise  of  medical  treatment,  at  the  outset,  rather  shocking 
to  the  school-boy,  the  undergraduate,  the  lawyer,  or  parson. 
He  resents  the  proposal  as  an  outrage  to  his  dignity  ;  de- 
clares that  he  was  sent  here  for  rest  and  remedies,  not  to  do 
laborer's  work,  that  such  toil  is  all  very  well  for  poor  people, 
but  not  for  gentlemen — that,  in  short,  he  will  have  none  of 
it.  His  repugnance,  however,  generally  yields  in  time  to 
reiterated  advice  and  the  example  of  others,  and,  once 
vanquished,  seldom   revives. 

"  The  result,  in  the  immense  majority  of  cases — I  might 


33^  n^suMJs. 

say  in  all, — is  beneficial.  Over  and  over  again  do  we  note 
instances  of  rapid  and  complete  recovery  following  steady 
application  to  outdoor  work,  when  other  means  have  signally 
failed  and  the  prognosis  has  become  decidedly  bad,  and, 
coincidently  with  the  mental  improvement,  the  establish- 
ment of  physical  robustness  and  vigor  such  as  the  patient 
has  not  often  previously  possessed.  Such  patients  have  the 
fresh,  ruddy  complexion,  fat  cheeks,  and  happy  contented 
aspect  which  one  observes  in  convalescents  from  typhoid 
fever." 

As  affecting  chronic  cases  and  respecting  the  comparative 
merits  of  employment  and  amusement,  Dr.  Francis  says  : 

"  In  the  treatment  of  chronic  insanity,  too,  outdoor  em- 
ployment, though  of  necessity  rarely  curative,  is  yet  of 
unquestionable  value.  A  chronic  lunatic  of  the  worst  type 
— turbulent,  noisy,  destructive,  treacherous,  violent,  faulty 
in  habits,  an  inveterate  nuisance — shows  marked  improve- 
ment after  a  few  months  of  steady  work.  Sleeplessness 
which  drugs  have  failed  to  influence  yields  to  healthy 
fatigue ;  he  no  longer  makes  a  scarecrow  of  himself  by 
tearing  his  clothes ;  his  opportunities  for  self-abuse  are 
much  curtailed  ;  and  he  relieves  his  angry  feelings  by 
vicious  digs  into  the  earth,  or  kicks  at  his  barrow  in  place 
of  murderous  attacks  upon  fellow  patients  or  attendants. 
Finally,  his  appetite  is  more  keen,  his  food  better  assimi- 
lated, and  his  general  health  improves.  Now  and  then  such 
a  patient  even  attains  a  state  of  fairly  permanent  partial 
recovery- — a  placid,  contented,  feeble-minded  condition,  it  is 
true,  but  still  enviable  in  comparison  with  his  former  miser- 
able existence. 

"  It  may  be  asked  whether  outdoor  amusements  with  ath- 
letic exercises  would  not  more  agreeably  serve  the  same  end. 
The  answer  must  be  in  the  negative.     For  one  patient  who 


EM  PL  0  YMEN  T.  337 

is  capable  of  taking  part  in  outdoor  games,  at  least  twenty- 
can  be  put  to  manual  work.  An  acute  maniac  or  a  dement 
can  be  made  nothing  of  on  the  cricket  field  or  tennis  lawn, 
though  he  may  dig  or  break  stones  with  energy  and  purpose. 
Moreover,  field  sports  and  athletics  are  apt  to  be  indulged  in 
spasmodically — a  few  hours  of  violent  exercise  and  excite- 
ment, followed  by  a  long  interval  of  rest  and  indolence.  .  .  . 
The  groundwork  of  recovery  is  found  by  experience  to  be 
best  laid  in  steady  plodding  within  the  hospital  boundaries  ; 
later,  when  convalescence  is  fairly  established,  play  may 
safely  vary  the  monotony  of  work,  or  even  be  substituted 
for  it,  though  frequently  such  a  patient,  recognizing,  as  he 
improves,  what  a  good  friend  work  has  been  to  him,  goes  on 
quite  contentedly." 

For  medical  reasons,  if  for  no  other,  it  would  seem  that 
a  rule  requiring  boarders  or  private  patients,  as  well  as 
paupers,  to  be  in  some  way  occupied  or  employed,  might 
be  made  applicable  in  every  case  where  the  condition  of 
the  patient  permits.  The  ennui  and  disgust  arising  from 
an  idle,  monotonous  daily  routine  of  life,  even  with  luxu- 
rious living,  are  almost  intolerable  to  a  sane  person,  and 
in  the  case  of  the  insane,  who  are  restricted  to  narrow 
limits,  frequently  lead  to  unhappy  results.  The  obser- 
vance of  the  foregoing  rule  has  proved  so  beneficial, 
where  enforced,  that  it  should  be  regarded  as  one  of  the 
leading  principles  of  treatment  in  all  hospitals  and  asylums 
for  the  insane. 

In  providing  employment,  the  welfare  of  the  patient,  and 
not  the  pecuniary  advantage  to  be  derived  from  his  labor, 
should  be  kept  constantly  in  view.  It  may  be  necessary  to 
exercise  as  much  watchfulness  to  prevent  some  patients 
from  over-exerting  themselves  as  tact  to  induce  others  to 
engage  in  any  occupation.     The  hours  for  work  should  be 


338  RESUME. 

limited,  the  whole  industrial  system  carefully  supervised, 
and  the  instructors  or  attendants  should  not  act  as  overseers, 
but  as  companions,  working  with  the  insane,  thus  dignifying 
labor  by  their  example.  In  every  case  due  regard  should  be 
had  to  the  mental  and  physical  condition  of  the  patient, 
which  should  be  ascertained,  as  is  done  in  some  asylums, 
by  a  medical  inspection  made  every  morning. 

REMUNERATION. 

The  custom  of  making  a  small  remuneration  or  granting 
special  favors  or  privileges  for  work  performed  by  the  insane, 
as  practised  at  Fitz-James,  Gheel,  and  some  other  places,  is 
spoken  of  with  much  satisfaction  by  superintendents  who 
have  tried  the  plan.  It  is  based  on  the  belief  that,  al- 
though a  man's  mental  faculties  are  impaired,  he  may  still 
have  understanding  enough  to  appreciate  an  act  of  kindness 
and  justice.  On  some  points  he  may  be  perfectly  rational 
and  intelligent,  and  may  know  and  sensitively  feel,  as  well 
as  any  of  his  sane  brethren,  that  labor  should  have  its  reward. 

In  the  Government  Asylum  for  insane  criminals  at  Broad- 
moor, England,  the  plan  of  making  money  payments  was  in- 
troduced in  1877,  and  after  a  fair  trial,  has  proved  highly 
beneficial  to  the  inmates  and  advantageous  to  the  asylum. 
The  value  of  the  labor  performed  is  estimated  by  the  hour 
or  by  the  piece,  one  eighth  being  credited  to  the  patient, 
which  he  may  expend  in  harmless  luxuries  or  have  sent  to  his 
family.  Each  has  a  book  of  forms  in  which  his  requisitions 
are  entered.  The  sum  paid  to  the  workers  amounts  to  about 
i^300  yearly. 

In  France,  the  principle  of  making  moderate  money  re- 
wards to  patients  who  work,  is  sanctioned  by  the  Government. 
The  Inspector-General  of  Insane  Asylums  in  that  country 
is  of  the  opinion  that  patients  should  receive  some  slight 


REMUNERA  TION.  339 

recompense  for  their  labor,  and  that  this  might  be  in  the 
gratification  of  some  pardonable  whim  or  in  a  money  pay- 
ment on  leaving  the  asylum  if  cured.  He  says  :  "  We  have 
here  a  moral  means  which  acts  powerfully  on  certain  natures. 
With  others  the  effect  is  not  so  marked,  but  were  no  other 
result  obtained  save  that  of  provoking  a  childish  joy,  it 
ought  not  to  be  despised."  The  French  system  is  thus 
of^cially  described  : 

"  Inasmuch  as  work  is  considered  a  therapeutic  agency,  it 
is  necessary  to  encourage  patients  to  devote  themselves  to 
it  with  a  certain  amount  of  assiduity.  All  work  deserves 
pay.  The  greater  part  of  the  insane  are  aware  of  that,  and 
insist  that  their  work  should  be  rewarded.  From  the  first 
month  a  certain  proportion  is  allotted  by  the  physician  in 
charge  to  a  fund  for  the  patient  on  his  discharge.  When 
the  discharge  fund  has  been  attained,  the  surplus  goes  to 
the  profit  of  the  patient,  to  be  devoted  to  Sunday  dress,  to 
articles  of  fancy  he  may  desire  to  purchase,  or  to  remit  in 
whole  or  in  part  to  his  relations.  All  these  favors  become 
in  the  hands  of  the  doctor  a  therapeutic  agency  of  a  certain 
importance,  and  they  are  a  satisfaction  to  the  patients,  which 
it  is  right  to  afford  them." 

Compensation  would  do  away  with  the  sense  of  injustice 
felt  by  many  of  the  insane  in  being  obliged  to  work  while 
confined  against  their  will.  Numerous  complaints,  in  some 
cases  very  bitter  ones,  have  been  made  to  me  by  patients 
in  insane  asylums  because  they  were  not  paid  any  thing 
for  their  services,  and  had  no  privileges  over  non-workers 
and  idlers.  Some  recompense  would  help  to  make  such 
persons  contented,  and  their  cheerful  spirits  would  animate 
others.  Dr.  ]\Iitchell,  of  the  South  Yorkshire  as}-lum  at 
Wadsley,  says  that  much  more  might  be  done  for  the  im- 
provement of  the  mental  and  bodily  health  of  the  insane  if 


340  RESUME. 

a  greater  number  could  be  induced  to  engage  in  labor.  In 
his  experience,  the  lack  of  compensation  to  workers  stands 
in  the  way  of  a  complete  industrial  system,  many  persistently 
refusing  to  work,  on  the  plea  that  they  have  never  worked 
without  remuneration. 

DRESS    AND    CLOTHING. 

Foreign  asylums  are  usually  kept  at  a  low  temperature, 
and  the  degree  of  heat  maintained  would,  in  this  country,  be 
considered  insufificient  for  the  health  and  comfort  of  a  large 
class  of  patients.  The  opinion,  however,  was  generally  ex- 
pressed by  the  superintendents  of  asylums  in  Great  Britain 
and  Ireland,  that  it  is  far  better  to  plentifully  provide 
warm  and  substantial  clothing  for  the  patients  than  to 
keep  their  rooms  at  a  high  temperature.  In  the  latter 
case  they  claim  that  the  inmates  become  more  sensitive 
to  the  cold  when  exposed,  and  consequently  cannot  derive 
the  great  benefit  which  may  be  secured  by  regular  outdoor 
exercise.  Although  the  winter  climate  of  England  is  less 
rigorous  than  ours,  the  clothing  of  asylum  inmates  seemed 
to  be  more  substantial  and  comfortable  than  that  furnished 
patients  here.  Stout  shoes  and  warm  woollen  socks  or 
stockings  are  worn.  High-collared,  heavy  cloaks  or  capes, 
buttoning  in  front  and  extending  over  the  shoulders  and 
arms  are  provided  in  some  of  the  asylums  for  patients  taking 
recreation  or  country  walks  in  raw  weather. 

Many  asylum  superintendents  deprecate  uniformity  in 
dress,  and  it  was  pleasing  to  observe  that  in  the  selection  of 
articles  worn  by  patients,  such  as  shawls,  capes,  ribbons, 
bonnets,  etc.,  their  preferences  as  to  color  and  pattern  were 
frequently  gratified. 

dii:tary  and  dining-rooms. 

In  some  asylums  in  England  and  Scotland,  where  male 
and  female  patients  dine  simultaneously  in  the  same  hall, 


DIETARY  AND  DINING-ROOMS,  34I 

the  practice  is  approved  by  superintendents,  on  the  ground 
that  it  is  more  in  accordance  with  the  ordinary  way  of 
living.  At  the  small  county  asylum  at  Haddington,  it 
has  long  been  the  custom  for  men  and  women  to  dine 
even  at  the  same  table,  and  no  inconvenience  has  resulted 
therefrom.  Attendants  usually  preside  at  the  ends  of  the 
tables.  As  a  general  rule,  it  is  desirable  that  tables,  each 
accommodating  a  limited  number  of  classified  patients, 
should  be  provided  in  the  dining-halls. 

Knives,  forks,  and  spoons  are  used  in  the  more  modern 
institutions.  The  knives  for  the  refractory  have  frequently 
blunt  edges,  with  the  exception  of  about  an  inch  and  a  half 
near  the  point.  In  Sweden,  wooden  spoons  are  provided  for 
this  class  of  patients.  In  most  of  the  large  asylums  visited, 
the  food  is  conveyed  to  the  dining-rooms  from  a  general 
kitchen. 

It  did  not  appear  that  the  variety  and  quality  of  food 
common  to  American  asylums  was  equalled  abroad.  In  the 
institutions  for  the  dependent  insane,  the  difference  was  quite 
marked,  the  foreign  dietary  being  far  less  generous.  The 
food  is  possibly  as  good  as  the  daily  fare  of  agricultural 
laborers  in  the  districts  from  which  patients  come,  but  me- 
chanics from  the  cities  find  it  inferior  to  that  to  which  they 
have  been  accustomed.  In  the  Scotch  institutions  the  accept- 
ability and  general  use  of  the  various  preparations  of  oatmeal 
promote  the  healthfulness  of  the  patients  and  at  the  same 
time  tend  to  reduce  the  cost  of  maintenance.  Much  less 
fresh  beef  is  consumed  in  foreign  asylums  than  in  those  of 
the  United  States,  and  there  is  not  the  variety  of  vegetables 
nor  the  abundance  of  palatable  fruits.  It  should  not  be 
forgotten  that  the  insane  need  a  nourishing  and  liberal  diet. 
If,  with  this,  they  are  well  employed,  they  improve  in  health 
and  become  more  orderly  and  quiet. 


342  RESUME. 

ALCOHOLIC    STIMULANTS. 

An  American  regards  with  surprise  the  extent  to  which 
alcohoHc  stimulants  are  used  in  foreign  asylums.  In  Great 
Britain  and  Ireland  and  some  other  parts  of  Europe,  their  use 
is  gradually  but  surely  decreasing.  It  is  computed  that  the 
quantity  consumed  in  county  asylums  in  England  dimin- 
ished fifty  per  cent  in  the  seven  years  preceding  1883,  ^"^ 
nearly  seventy-five  per  cent  in  borough  asylums  during  the 
same  period.  One  of  the  managers  of  the  Brookwood 
asylum  asserts  that  where  the  use  of  alcoholic  stimulants 
is  lessened,  fewer  drugs  and  narcotics  are  found  necessary ; 
and  that  the  substitution  of  milk  in  large  quantities  for 
beer,  ale,  and  spirits  is  attended  with  the  best  results. 
The  English  Commissioners  in  Lunacy  state  that  in  English 
county  and  borough  asylums  the  amount  of  surgery  and 
dispensary  expenditures  is  lowest  where  the  consumption  of 
wines,  spirits,  and  porter  is  smallest.  A  superintendent  of 
one  of  the  English  asylums  assured  me  that  the  giving  up 
of  beer  in  his  own  asylum,  except  for  medicinal  purposes, 
had  proved  beneficial,  the  patients  usually  eating  more,  and, 
in  a  majority  of  cases,  gaining  in  weight.  In  the  summer 
of  1884,  Dr.  D.  Hack  Tuke,  in  gathering  statistics  on  this 
subject,  found  that,  out  of  one  hundred  returns  made  to 
him  from  different  county  and  borough  asylums  and  reg- 
istered hospitals,  one  half  showed  the  non-use  of  alcohol 
except  as  administered  medicinally,  the  officers  generally 
reporting  that  the  discipline  of  the  asylum  had  at  the 
same  time  improved. 

SOCIAL    DISTINCTIONS. 

The  attempt  to  make  a  classification  based  on  social 
standing  is  a  cause  of  great  embarrassment  in  some  of  the 
foreign  asylums.      The  inconvenience  resulting   therefrom, 


VISIT  A  TION.  343 

was  strikingly  apparent  at  Hamburg.  At  Halle,  even  in  the 
small  cottage  hospital  for  sick  women,  provision  was  made 
for  two  classes.  The  arrangements  necessary  to  carry  out 
such  a  system,  increase  the  cost  of  care  and  lessen  the 
available  capacity  of  the  institution,  as  there  may  be  lack 
of  space  for  one  class  while  there  is  an  excess  for  another. 
The  observance  of  these  social  distinctions  also  stands  in 
the  way  of  a  proper  classification  based  on  the  mental 
and  bodily  condition  of  the  patients. 

VISITATION. 

In  Great  Britain  and  on  the  Continent  the  evil  of  excessive 
visitation  by  habitual  sight-seers  and  by  people  whose 
motives  are  simply  to  gratify  an  idle  curiosity,  is  not  so 
great  as  in  some  parts  of  the  United  States.  While  asylum 
visitation  is  free  to  those  in  authority,  the  admission  of  the 
public  is  subject  to  rule.  Even  pauper  institutions  enjoy 
comparative  seclusion.  At  Haywards  Heath,  and  also  at 
some  other  asylums,  friends  are  not  allowed  to  visit  a 
patient  until  a  month  after  the  date  of  his  admission,  and 
they  are  then  admonished  to  say  nothing  that  may  depress 
or  disturb  him. 

It  would  seem  that  to  the  misfortune  of  insanity  should 
not  be  added  the  mortification  felt  by  a  patient  in  conse- 
quence of  public  exposure  while  under  care  and  treatment. 
It  sometimes  happens  in  our  asylums  that  the  strange 
delusions  of  an  insane  person  are  treated  with  idle  jest  or 
thoughtless  ridicule  by  visitors,  and  his  excitement  thereby 
increased.  Visiting  by  relatives  and  those  actually  interested 
in  the  insane  should  be  permitted  under  proper  statutory 
regulations,  to  such  an  extent  as  will  preserve  the  confidence 
of  the  public  in  the  asylum  and  further  good  administra- 
tion ;     but     to    exhibit     patients     to    curious    visitors     and 


344  RESUME. 

point  out  their  grotesque  characteristics,  as  is  sometimes 
done,  in  much  the  same  way  that  animals  are  shown  in  a 
menagerie,  cannot  be  considered  other  than  an  outrage  to 
them  and  an  injustice  to  their  friends  and  relatives.  It 
should  not  be  forgotten  that,  in  an  asylum,  the  patient  is 
entitled  to  as  much  of  his  former  privacy  as  is  compatible 
with  his  peculiar  mental  condition. 

LETTERS. 

Respecting  the  disposal  of  letters,  always  a  source  of 
more  or  less  embarrassment  in  asylum  management,  an  act 
of  the  British  Parliament,  passed  in  1862,  requires  that  in 
England  every  letter  addressed  by  a  private  patient  to  the 
Lunacy  Commissioners  must  be  forwarded  to  them  un- 
opened. Those  addressed  to  others  are  left  to  the  discre- 
tion of  the  asylum  superintendent.  Such  as  he  thinks 
should  not  be  mailed  must  be  brought  to  the  attention  of 
the  Commissioners  in  Lunacy,  the  Visitors,  or  the  Commit- 
tee when  making  their  next  inspection.  The  opinion  of 
the  late  Chairman  of  the  English  Lunacy  Board  respect- 
ing the  detention  of  letters  was  given  to  the  special  parlia- 
mentary committee  of   1877  in  the  following  language  : 

"  I  am  inclined  to  think  that  the  correspondence  is  very 
fairly  carried  on  ;  that  letters  that  ought  to  be  sent  are 
really  sent  by  the  great  mass  of  superintendents.  I  cannot 
have  a  doubt  that  it  is  so.  All  letters  that  are  not  sent  are 
reserved  for  the  Visitors  or  the  Commissioners  at  their  next 
visit.  On  inquiring  the  other  day  I  found  there  were  very 
few  instances  indeed  in  which  the  Commissioners  or  the 
Visitors  upon  opening  those  letters  thought  they  ought  not 
to  have  been  kept  back.  No  doubt  the  superintendents  of 
asylums  have  very  great  power,  and  they  might  keep  back 
a  great  number  of  the  letters  that   ought  to  be   forwarded. 


LETTERS.  345 

I  do  not  think  they  do  it,  and  I  do  not  think  they  are 
inclined  to  do  it :  the  responsibility  is  very  serious.  I  do 
not  think  they  keep  back  any  correspondence  but  that 
which  they  think  would  be  positively  hurtful ;  and  such 
must,  of  course,  be  detained.  Some  of  it  is  of  the  most 
blasphemous  and  obscene  character.     .     ,     . 

"  There  are  some  patients  who  have  a  positive  frenzy  for 
writing.  I  have  a  correspondent  in  Sussex  House  who  fa- 
vors me  periodically  with  some  of  the  longest  letters  I  ever 
saw.  They  are  invariably  sent  to  me,  and  I  do  myself  the 
honor — I  cannot  say  the  pleasure — of  reading  them.  The 
man  boasted  to  me  the  other  day  that  he  had  written  no 
less  than  one  hundred  and  twenty  letters  within  the  last 
month.  You  can  hardly  think  that  all  those  could  be  for- 
warded." 

The  statute  regulating  the  transmission  of  letters  in  Scot- 
land is  as  follows  :  "  Every  letter  written  by  a  patient  in 
any  asylum  or  house,  and  addressed  to  the  Board  or  their 
Secretary,  or  the  Commissioners  in  Lunacy,  or  any  of  them, 
shall,  unless  special  instructions  to  the  contrary  have  been 
given  by  such  Commissioners,  or  any  of  them,  be  forwarded 
to  its  address  unopened  ;  and  every  letter  from  the  Board 
or  their  Secretary,  or  such  Commissioner  or  Commissioners, 
to  any  such  patient,  when  marked  '  Private  '  on  the  cover, 
shall  be  delivered  to  him  unopened  ;  and  every  person  who 
shall  intercept  or  detain  or  shall  open  any  such  letter  with- 
out the  authority  of  the  patient  by  whom  it  is  written  or  to 
whom  it  is  addressed,  shall  be  liable  in  a  penalty  not  exceed- 
ing ten  pounds  :  provided  that  the  Board  shall  transmit  a 
copy  of  such  letter  to  the  superintendent  of  such  asylum  or 
house  if  it  shall  appear  to  the  Board  that  the  contents  of  the 
letter  are  of  such  a  nature  that  it  is  of  importance  that  the 
superintendent  should  be  made  acquainted  therewith."    The 


34^  RESUME. 

superintendent  exercises  his  discretion  in  regard  to  other 
letters. 

In  accordance  with  the  law  of  Massachusetts,  locked 
boxes  are  placed  so  as  to  be  accessible  to  the  patients  in 
asylums  ;  and  into  these,  letters  can  be  dropped,  which 
must  be  forwarded  unopened  to  the  Commissioners  of 
Lunacy  and  Charity.  The  law  has  been  in  operation  since 
1874,  and  the  opinion  of  one  intimate  with  its  workings 
during  that  time  is  valuable.  Mr.  F.  B.  Sanborn,  Inspector 
of  Charities  for  Massachusetts,  expresses  himself  in  favor  of 
the  law.  Although  the  great  mass  of  letters  that  find  their 
way  into  the  boxes,  he  says,  are  little  else  than  rubbish,  by 
their  use  a  legalized  means  of  communication  with  the  out- 
side world  is  secured,  which  affords  satisfaction  to  many 
of  the  insane  and  possibly  to  their  friends. 

It  would  seem  that  the  law  should  provide  some  means 
whereby  State  supervising  authorities  and  patients  can  com- 
municate directly  with  each  other,  as  in  Scotland,  and  that 
all  letters  not  forwarded  to  friends  of  patients  by  the  asylum 
superintendent  should  be  held  for  the  inspection  of  the  su- 
pervising commissioners,  whose  duty  it  should  be  to  exam- 
ine the  same  when  next  visiting  the  institution. 

POST-MORTEM    EXAMINATIONS. 

There  is  no  uniform  rule  as  to  the  making  oi  post-mortem 
examinations  in  the  English  county  and  borough  asylums. 
The  general  practice  is  that  of  communicating  with  relatives 
or  friends  in  the  event  of  the  death  of  a  patient,  sometimes 
stating  that  an  examination  will  be  necessary  ;  and  if  there 
is  no  objection,  an  autopsy  is  made.  At  St.  Luke's  Hospi- 
tal it  is  set  forth  in  the  printed  form  of  admission  that,  un- 
less objection  shall  have  been  made  in  writing  to  the  asylum 
secretary  previous  to  the  decease  of  a  patient,  7\.  post-mortem 


ADMISSION  AND   DISCHARGE.  347 

examination  will  be  held.  In  some  institutions  very  few  are 
made  ;  while  in  others  they  are  made  in  nearly  every  case. 
During  the  year  ending  January  i,  1887,  out  of  5,053  deaths 
in  the  English  county  and  borough  asylums,  3,649  post- 
mortem examinations  were  made.  The  practice  is  thought 
desirable  by  the  English  Commissioners  in  Lunacy  when- 
ever possible,  and  with  the  observance  of  the  same  rule  as  to 
the  consent  of  friends  or  relatives  of  all  classes  of  patients. 
Besides  the  advantage  to  be  derived  from  these  examina- 
tions in  advancing  the  knowledge  of  the  pathology  and 
treatment  of  various  forms  of  insanity,  the  commissioners 
deem  them  desirable  as  a  means  of  discovering  injuries,  and 
think  the  evidence  of  possible  maltreatment  that  may  be 
thus  obtained  is  a  protection  to  the  insane. 

ADMISSION     AND    DISCHARGE. 

While  every  possible  precaution  should  be  taken  to  guard 
against  violations  of  personal  liberty,  the  process  of  entering 
an  asylum  should  not  be  so  hedged  in  with  needless  forms 
as  to  prevent  the  speedy  admission  of  the  patient.  The 
highest  medical  authorities  concur  in  the  opinion  that  early 
treatment  of  insanity  is  essential  to  the  attainment  of  suc- 
cessful results,  and  that  loss  of  time  is  disastrous  by  making 
permanent  the  departure  from  normal  action  which,  under 
favorable  conditions,  might  have  been  quickly  restored.  To 
facilitate  the  early  entrance  of  an  insane  person  into  an 
asylum,  no  more  publicity  should  attend  the  transfer  than  is 
necessary.  An  objection  to  the  system  of  trial  by  jury  is 
that  the  dread  of  public  exposure  incident  to  this  mode  of 
procedure  frequently  delays  action  by  friends  of  the  patient 
until  special  remedial  measures  come  too  late.  Besides,  the 
excitement  experienced  by  the  patient  when  forced  to  ap- 
pear before  a  court  and  jury  as  in  a  criminal  process,  con- 


348  RESUME. 

fronted  by  adverse  witnesses  whom  he  had  hitherto  regarded 
as  trusted  friends,  has  often  a  very  damaging  effect  upon 
him. 

The  dividing  line  between  sanity  and  insanity  is  usually 
so  imperceptible  that  it  is  difficult  to  fix  the  precise  period 
when  a  person  enters  the  first  stage  of  mental  disease. 
Dr.  James  Coxe  has  truly  said :  *'  As  day  passes  grad- 
ually into  night,  so  does  sanity  pass  gradually  into 
insanity."  In  beginning  treatment  we  should  therefore 
come  as  near  to  this  uncertain  line  as  practicable.  It  is 
better  that  we  should  err  by  sending  the  sufferer  to  the 
hospital  too  early  rather  than  too  late,  always  providing  for 
easy  means  of  egress  as  soon  as  he  is  in  a  condition  to 
justify  his  leaving.  When  the  nature  of  insanity  and  the 
necessity  of  special  hospital  treatment  are  generally  well 
understood,  when  the  laws  governing  admission  and  dis- 
charge come  to  be  perfected,  and  when  other  desirable 
reforms  are  effected,  there  will  be  little  if  any  more  reluc- 
tance on  the  part  of  friends  to  place  a  patient  in  a  hospital  for 
the  treatment  of  mental  than  one  for  the  treatment  of 
bodily  disease. 

It  is  important  that  the  relations  between  the  patients  and 
the  superintendent  of  an  asylum  should  be  of  the  most 
friendly  nature,  and  that  the  latter  should  enjoy  the  unre- 
served confidence  of  his  wards.  This  cannot  be  the  case  if 
the  patient  thinks  that  he  is  entitled  to  his  discharge,  but 
fancies  that  it  is  withheld  through  the  selfishness  or  caprice 
of  the  superintendent.  Feeling  that  a  tyrannical  power  is 
exercised  over  him,  the  patient  is  irritated  whenever  he  sees 
his  imagined  oppressor.  It  has  been  my  frequent  experi- 
ence, in  passing  through  the  wards  of  an  asylum  with  the 
medical  superintendent,  to  hear,  on  every  side,  entreaties 
to  and  maledictions  against  him,  the  inmates  believing  that 


ADMISSION  AND   DISCHARGE.  349 

he  held  the  key  to  their  freedom  and  wrongfully  detained 
them.  It  would  appear  that  the  power  to  grant  discharge 
should  be  vested  in  other  authority  than  the  superintendent. 
Should  he  be  relieved  of  this  responsibility,  he  would 
be  placed  on  a  more  friendly  footing  with  his  patients  and 
be  able  to  administer  more  effectually  to  their  recovery. 

As  a  safeguard  against  unnecessarily  prolonged  detention, 
it  would  seem  desirable  that,  after  a  patient  had  been  in  an 
institution  three  years,  an  affidavit  as  to  the  necessity  of 
his  further  care  therein  should  be  made  yearly  by  the 
authority  in  which  is  vested  the  power  of  discharge.  This, 
although  perhaps  of  little  account  as  affecting  the  num- 
bers released,  would  doubtless  be  a  satisfaction  to  friends 
of  patients  and  to  the  public. 

The  power  exercised  by  the  Scotch  Lunacy  Board  to  dis- 
charge upon  a  certificate  of  recovery  granted  by  two  physi- 
cians whom  they  have  called  to  make  a  special  examination, 
is  a  very  satisfactory  way  of  meeting  the  question  of  discharge 
in  controverted  or  doubtful  cases.  The  power  vested  in  the 
sheriff  (county  judge)  to  discharge  upon  a  proper  certificate 
presented  to  him  by  two  reliable  medical  men,  to  the  effect 
that  the  patient  is  either  recovered  or  is  not  dangerous  to 
himself  or  the  public,  makes  the  exit  from  an  asylum  in  Scot- 
land easy  and  encourages  resort  to  early  asylum  treatment. 

The  granting  of  probationary  discharges, — that  is  to  say, 
permitting  a  certain  class  of  patients  to  go  out  on  trial  to 
their  homes,  to  work  for  wages,  or,  under  the  guardianship 
of  friends,  to  the  mountains  or  the  sea-side,  appears  to  be  at- 
tended with  good  results.  The  practice  is  in  favor  with  the 
Scotch  Lunacy  Board,  and  in  England  it  is  becoming  more 
prevalent. 

Li  the  disagreeable  task  of  taking  an  insane  person  to  an 
asylum,  the  relatives  or  friends  should  only  participate  when 


350  RESUME. 

their  doing  so  would  be  helpful  to  the  patient ;  and  they 
should  endeavor  to  show  him  that  his  going  is  unavoidable, 
and  that  they  deplore  its  necessity.  Strategy  and  deceit  are 
frequently  resorted  to  in  making  these  transfers,  and  it  is 
an  embarrassing  task  for  the  superintendent  of  an  asylum  to 
undeceive  the  person  brought  to  his  care  under  such  cir- 
cumstances. He  is  thus  placed  in  an  equivocal  position, 
and  at  the  outset  is  looked  upon  with  distrust  by  the  pa- 
tient, who  should,  for  his  own  sake,  have  entire  confidence 
in  the  one  with  whom  he  is  brought  into  such  intimate 
relations  and  who  is  to  control  his  future  destiny.  An 
insane  person  should  never  be  deceived,  but  first,  last,  and 
always  told  the  truth.  The  burden  of  his  complaint  is, 
that  he  is  the  victim  of  a  conspiracy  among  his  friends. 
Believing  himself  to  be  sane,  how  could  an  insane  man  feel 
otherwise  than  deeply  wronged  at  the  treachery  of  those 
whom  he  had  always  trusted  and  loved  ?  His  worst  pas- 
sions are  aroused,  and  a  sense  of  desolation  and  bitterness 
adds  to  the  tumult  of  his  disordered  mind.  In  the  transfer 
of  female  patients  to  asylums,  the  statute  should  require 
that  they  have  the  protection  that  the  companionship  of  a 
competent  female  attendant  affords.  For  obvious  reasons, 
all  transfers  should  be  so  arranged  as  to  avoid,  if  possible, 
reaching  the  asylum  at  night. 

VOLUNTARY    PATIENTS. 

In  England,  a  person  that  has  once  been  an  inmate  of  an 
insane  asylum  can,  by  payment  of  board,  be  re-admitted  at 
his  own  request,  if  this  shall  be  made  within  five  years  after 
his  discharge.  The  procedure  respecting  the  admission  of 
voluntary  patients  into  asylums  in  Scotland  has  already  been 
described.  So  far  as  I  could  learn,  the  operation  of  the 
Scotch  law  relating  to  this  class  of  patients  had  proved  satis- 


SUMMER  RESORTS.  35  I 

factory.  In  1881,  Massachusetts  passed  a  law  permitting 
persons  to  enter  asylums  voluntarily.  During  the  five  years 
after  the  enactment  of  the  statute,  there  were  261  admissions 
under  it,  thirty-five  of  which  were  re-admissions.  All  of 
those  admitted  except  forty-two  had,  on  January  i,  1887, 
been  discharged.  During  the  year  1886,  about  one  third  of 
the  admissions  to  the  McLean  Asylum,  Massachusetts,  were 
voluntary.  The  admission  of  this  class  of  patients  into  in- 
sane asylums  tends  to  do  away  with  the  air  of  mystery  and 
feeling  of  dread  with  which  these  institutions  are  sometimes 
invested  in  the  public  mind. 

SUMMER    RESORTS. 

It  has  been  shown  that  some  of  the  foreign  asylums,  nota- 
bly Morningside  andthe  York  Retreat,  take  their  patients  in 
the  convalescing  stage,  at  seasonable  times,  to  sea-side  re- 
sorts. This  praiseworthy  custom  is  also  observed  on  this 
side  of  the  water  by  the  McLean  Asylum  in  Massachusetts 
and  the  Friends'  Retreat  in  Pennsylvania.  The  advantages 
sought  may  also  be  secured  at  other  places  than  the  sea- 
side. Attractive  points  upon  the  shores  of  our  beautiful 
lakes  and  near  our  magnificent  rivers,  or  among  the  moun- 
tains, would  afford  the  desired  change.  Judging  from  the 
beneficial  effects  which  have  resulted  from  a  change  of  scene 
and  air,  it  would  seem  advisable  to  extend  the  privilege  as 
far  as  possible  to  all  patients  likely  to  be  benefited  thereby. 
The  removal  need  not  involve  a  large  outlay,  as  suitable 
premises  could  be  secured  by  rental,  and  temporary  struc- 
tures, or  even  tents,  could  be  made  to  answer  the  pur- 
pose of  shelter.  Such  resorts  should  not  be  called  by  any 
name  suggestive  of  insanity. 

CRIMINAL    INSANE. 

Separate  provision  should  be  made  by  every  State  for  in- 
sane criminals.     The  necessity  for  this  is  so  apparent,  if  con- 


352  RESUME. 

sidered  only  with  reference  to  the  rights  of  the  non-criminal 
insane,  as  seemingly  to  need  no  argument.  What  has  been 
done  by  the  English  Government  at  Broadmoor  and  what 
New  York  State  is  now  doing  under  the  intelligent  super- 
vision of  Dr.  Carlos  F.  MacDonald,  Superintendent  of  the 
State  Asylum  for  Insane  Criminals,  demonstrate  the  advan- 
tages of  providing  separate  establishments  for  the  criminal 
insane. 

BOARDING-OUT. 

The  number  of  insane  provided  for  in  private  dwellings 
in  continental  countries  aside  from  Belgium  is  not  easily 
obtainable.  It  is  doubtless  considerable.  There  is  a  large 
number  in  family  care  in  Ireland.  On  the  1st  of  January, 
1887,  there  were  in  England  5,809  pauper  lunatics  "not 
confined  in  any  asylum,  hospital,  or  licensed  house,  but 
residing  with  relatives  or  others  as  outdoor  paupers." 
These  formed  8.02  per  cent  of  the  whole  number  of  pau- 
per lunatics.  As  idiots  are  included  in  the  term  lunatic, 
what  proportion  were  insane  cannot  be  determined  from  the 
statistics  given.  During  the  ten  years  preceding  1887,  the 
number  of  outdoor  pauper  lunatics  in  England  decreased  503. 
There  is  no  general  system  for  boarding  out  the  insane  under 
governmental  supervision  either  in  England  or  Ireland. 

On  the  1st  of  January,  1877,  the  insane  boarded  in  private 
dwellings  in  Scotland  numbered  1,418  and  a  decade  later 
there  were  2,140,  being  an  increase  of  722.  This  increase  may 
be  partly  due  to  the  protection  afforded  by  the  watchful 
supervision  of  the  Scotch  Lunacy  Board — a  kind  of  super- 
vision which  is  essential  to  the  success  of  the  boarding-out 
system.  The  opinions  of  this  Board  already  given  and  of 
the  officers  connected  with  it,  who  bestow  special  attention 
on  the  important  work  of  visiting  the  insane  placed  under 
family  care  are  worthy  of  careful  consideration. 


BOARDING-OUT.  353 

It  is  not  improbable  that,  if  a  searching  inquiry  were 
made  into  the  state  of  the  insane  in  private  dwelHngs  in  the 
several  countries  except  Scotland,  an  unsatisfactory  condi- 
tion, showing  much  abuse  and  neglect,  would  be  revealed. 

Among  the  chronic  insane  in  American  asylums  there  are 
doubtless  many  harmless  lunatics  who  could  be  removed 
from  asylum  to  family  keeping,  if  a  proper  and  cfificient 
system  of  supervision  were  extended  over  them.  As  the 
country  grows  older  and  the  dying  out  of  industries  in 
certain  localities  causes  the  people  to  resort  to  new  expedi- 
ents to  earn  a  living,  the  boarding  of  the  insane  will  be  taken 
up  if  the  way  is  legally  opened  for  it.  This  has  already 
proved  to  be  the  case  in  some  parts  of  Massachusetts,  where 
the  experiment  of  boarding  out  on  a  small  scale  under  the 
supervision  of  the  Board  of  Lunacy  and  Charity  has  been 
attended,  according  to  the  opinion  of  the  Board,  with 
satisfactory  results.  An  advantage  derived  by  the  public 
from  the  boarding-out  of  the  insane  is  that  it  is  relieved  from 
the  expense  of  providing  and  maintaining  shelter  for  them. 
The  benefits  accruing  to  the  insane  are  that  they  are  thus 
permitted  to  enjoy  greater  freedom  and  the  natural  sur- 
roundings and  associations  of  home  life.  As  to  the  question 
of  economy,  if  we  take  the  same  standard  of  diet  and  bodily 
comfort  for  both  asylum  and  family  care,  with  a  complete 
and  efficient  method  of  supervision  in  the  latter  case,  the 
cost  of  maintenance  in  families,  it  is  believed,  cannot  be 
made  much  if  any  less  than  in  asylums. 

While  it  is  due  the  insane  that  every  reasonable  require- 
ment of  humanity  should  be  met  in  providing  for  their  care 
and  treatment,  we  should  not  overlook  the  rights  of  the  sane. 
Therefore,  in  extending  the  boarding-out  system  in  this 
country,  as  will  undoubtedly  be  done,  it  is  desirable  to  keep 
in   mind  the  welfare  of  the  communities  anions'  which  the 


354  RESUME. 

insane  are  placed  and  note  the  effects  of  the  interminghng. 
A  no  less  rigorous  supervision  should  be  maintained  than  in 
Scotland,  and  the  selection  of  patients  for  family  care  should 
be  governed  by  even  stricter  rules  than  those  observed  in 
that  country. 

POORHOUSES. 

In  all  the  countries  visited,  an  examination  was  made  of 
institutions  variously  designated  as  poorhouses,  workhouses, 
and  alms-houses.  Such  of  them  as  contained  insane  per- 
sons, either  in  their  ordinary  wards  or  in  separate  depart- 
ments, were  carefully  inspected,  and  the  condition  of  the 
insane  noted.  It  was  found  that  the  provision  for  their 
care  did  not  reach  a  proper  standard.  The  workhouse 
establishments  in  England,  primarily  designed  for  sane 
paupers,  have  limited  opportunities  for  special  treatment 
of  the  insane.  In  many  places  lunatics  are  not  separated 
from  other  inmates,  and  where  it  is  done  the  indoor  space 
allotted  them  is  contracted  and  the  yards  for  recreation 
small.  From  a  lack  of  trained  attendants  there  is  insuffi- 
cient supervision,  and  other  essentials  to  proper  care  are 
wanting. 

Respecting  the  care  of  the  insane  in  workhouses,  the 
English  Commissioners  say :  "  Boards  of  guardians  are  not 
always  ready  to  adopt  our  suggestions  as  to  the  employing 
of  paid  attendants  to  look  after  the  imbecile  inmates,  in 
cases  where  their  number  appears  to  us  to  require  such 
attention  ;  nor  can  we  always  obtain  a  recognition  of  the 
need  for  a  diet  superior  to  that  which  is  found  sufficient  for 
the  ordinary  inmates."  Inspector  Henley  informed  me  that, 
in  th(,'  fifty-eight  Unions  under  his  supervision,  there  was  but 
little  separate  care  for  the  insane,  Birmingham  being  the 
only  one  having  large  separate  wards  ;  but  that  in  some  six  of 


POORHOUSES.  355 

the  Unions  there  were  small  wards  for  epileptics  and  trouble- 
some cases,  and  that  imbeciles  and  idiots  usually  occupy 
the  common  ward,  where  they  are  more  likely  to  annoy 
others  than  to  suffer  themselves.  Mr.  Henley,  who  has  had 
large  experience  as  an  inspector  of  workhouses,  is  of  the 
opinion  that  workhouse  provision,  although  in  separate  de- 
partments, is  wholly  unsuited  to  the  needs  of  the  insane,  and 
not  in  keeping  with  the  interests  of  rate-payers.  He  strongly 
favors  separate  asylums  for  this  class. 

If,  from  the  examinations  made,  one  conviction  forced 
itself  upon  my  mind  more  strongly  than  another,  it  was 
that  poorhouse,  workhouse,  or  alms-house  care,  whether  in 
common  with  sane  paupers  or  in  separate  departments,  but 
under  the  same  control  and  management,  is  not  humane, 
and  is  in  many  ways  unsatisfactory.  In  keeping  two  classes 
under  the  same  management  the  constant  tendency  is  to 
the  adoption  of  a  uniform  standard  of  care.  Provision 
that  would  be  adequate  to  the  needs  of  the  average  poor- 
house  inmate  is  quite  inadequate  to  the  necessities  of  the 
insane. 

No  statute  can  justly  place  common  paupers  and  the  in- 
sane on  the  same  plane.  The  former  come  under  public 
care,  in  the  majority  of  cases,  through  improvidence,  or 
physical  infirmity  caused  by  licentious  or  criminal  ways  of 
life;  the  latter  reach  a  condition  of  peculiar  helplessness  and 
dependence  from  mental  disease,  frequently  the  result  of 
causes  for  which  they  are  not  to  blame.  The  insane  are 
designated  by  Blackstone  as  "  the  victims  of  accidental  mis- 
fortune," which  cannot  be  said,  as  a  rule,  of  the  inmates  of  a 
poorhouse.  It  is  therefore  unjust  that  the  insane  should  be 
denied  special  care  and  treatment  and  that  they  should  be 
made  to  bear  the  stigma  consequent  upon  classification  and 
association  with  ordinary  paupers. 


35^  RESUME. 

LOCAL    OR    DISTRICT    CARE. 

In  some  of  the  States  of  this  country  there  is  a  strong  and 
growing  public  sentiment  in  favor  of  local  or  district  care 
for  the  chronic  insane.  Accepting  it  as  a  probability  that 
local  care  will  continue  to  extend  as  population  increases 
and  the  numbers  of  the  chronic  insane  multiply,  and  having 
in  view  the  fact  that  many  populous  localities  have  already 
elected  to  permanently  provide  for  their  chronic  insane,  it 
appears  to  be  of  very  great  importance  that  careful  consid- 
eration should  be  given  to  the  kind  of  provision  made  for 
them,  and  to  the  question  of  their  supervision  and  manage- 
ment. I  am  clearly  of  the  opinion  that  when  large  munici- 
palities, populous  counties,  or  congeries  of  counties  decide 
to  make  local  provision  for  this  class,  the  following  principles 
should  be  regarded  as  fundamental : 

1.  The  chronic  insane  should  be  placed  under  indepen- 
dent, non-partisan  boards  of  management,  the  members  of 
which  should  be  appointed  by  one  of  the  courts  for  long 
terms,  and  should  be  unsalaried.  These  boards  should  be 
governed,  as  near  as  may  be,  by  the  same  rules  that  govern 
boards  of  managers  of  State  asylums. 

2.  Accommodation  entirely  separate  from  that  for  sane 
paupers,  should  be  provided  on  considerable  tracts  of  good 
land,  conveniently  accessible  by  rail  or  water. 

3.  The  financial  and  other  transactions  should  be  kept 
separate  from  those  relating  to  the  relief  of  ordinary 
paupers. 

4.  The  standard  of  care  should  be  such  as  to  meet  the 
approval  of  State  authorities. 

In  this  way  it  is  believed  a  disinterested  and  intelligent 
government  of  these  institutions  may  be  secured,  with  the 
advantages  resulting  from  accumulating  experience,  a  con- 
tinuous administration,  and  a  uniform  policy.     This  cannot 


STATE   WARDS.  357 

be  the  case  under  the  present  county  system,  with  its  fre- 
quent change  of  officers  and  the  recognized  custom  of 
making  institutions  for  the  poor  in  a  greater  or  less  degree 
mediums  for  the  distribution  of  political  patronage. 

STATE     WARDS. 

From  the  information  obtained,  I  am  led  to  believe  that  in 
Europe  as  well  as  in  the  United  States  the  attempt  of  rela- 
tives in  moderate  circumstances  to  pay  for  the  board  of  a 
member  of  the  family  in  an  institution  for  the  insane  at 
the  rates  charged  often  results  in  great  hardship.  Officials 
connected  with  public  relief  in  some  of  the  States  of  this 
country  are  aware  that  it  frequently  happens  that  the  efforts 
made  by  a  family  to  support  one  of  its  number  in  an  insane 
asylum  have  completely  pauperized  it  and  brought  its 
remaining  members,  including  children  of  tender  age,  upon 
the  public  for  support.  In  Illinois,  Indiana,  Ohio,  and 
Minnesota,  where  free  provision  is  made  for  the  insane  by 
the  State,  such  cases  of  distress  and  breaking  up  of  families 
do  not  occur.  The  law  making  the  care  of  the  insane  a 
State  charge  is  primarily  based  on  the  principle  that  when 
the  tax-paying  citizen  becomes  insane  he  is  no  less  entitled 
to  the  special  care  of  the  State  than  the  citizen  who  does  not 
pay  a  tax. 

In  New  York  and  some  other  States  the  asylums,  while 
ostensibly  designed  for  the  dependent  class,  are  open  to  citi- 
zens of  the  State  who  are  not  dependent.  The  maintenance 
and  care  of  such  become  a  charge  against  those  liable  for 
their  support.  This  charge  is  in  excess  of  that  made  for  the 
care  of  the  dependent  class.  Many  citizens  of  small  means 
arc  unable  to  bear  so  heavy  a  burden,  and  they  should  not 
be  required  to  pay  more  than  the  rate  charged  local  author- 
ities for  the  maintenance  and  care  of  pauper  patients.     If 


358  RESUME. 

such  a  rule  were  observed,  the  pecuniary  distress  incident  to 
the  present  system  would  be  greatly  alleviated. 

Respecting  the  policy  of  providing  for  the  dependent  in- 
sane, it  would  seem  to  be  wise  for  every  State  to  furnish  free 
hospital  treatment  of  the  kind  already  described  for  those 
coming  under  the  general  term  of  the  acute  insane.  If  State 
care  were  free  to  such  cases,  prompt  transfers  to  hospitals 
would  be  encouraged  and  the  great  advantages  resulting 
from  early  treatment  would  be  more  generally  secured. 

As  to  the  care  of  the  dependent  chronic  insane  in  States 
not  having  a  free  system,  it  appears  to  me  that  this  class 
might  with  advantage  be  received  into  State  asylums  from 
local  authorities  at  a  very  liberal  rate  fixed  by  statute — one 
that  would  be  less  than  it  would  cost  such  authorities  to 
maintain  them  at  a  proper  standard  of  care  at  home  ;  and  that 
to  such  municipalities,  counties,  and  districts  as  should  elect 
to  provide  for  their  own  quiet  and  harmless  chronic  insane 
a  yearly  per-capita  allowance  might  be  made  by  the  State  of 
the  difference  between  the  rate  fixed  by  legislative  enact- 
ment and  the  actual  cost  of  home  support,  but  not  beyond 
what  it  had  cost  the  State  to  maintain  the  insane  in  its 
chronic  asylums,  it  being  provided  that  the  standard  of  care 
be  verified  by  State  authorities  as  equal  to  State  asylum  care, 
and  that  the  insane  be  placed  under  such  separate  local 
boards  as  have  already  been  recommended.  It  will  be  seen 
that  the  making  of  an  allowance  by  the  State  in  the  manner 
proposed  would  be  somewhat  analogous  to  the  action  of 
Parliament  in  granting  four  shillings  a  week  per  capita  to 
local  authorities  in  England,  Scotland,  and  Ireland  when 
providing  for  their  insane  a  standard  of  care  satisfactory  to 
the  State- — a  form  of  relief  that  has  proved  highly  benefi- 
cial to  the  dependent  insane  in  those  countries. 

The  extending  conditionally  of  State  aid  is  an  acknowledg- 


PUBLIC  ACCOUNTS,  359 

ment  of  a  continuous  obligation  on  the  part  of  the  State, 
and  its  acceptance  by  local  authorities  is  a  recognition  of  the 
principle  of  State  wardship  of  the  insane.  Deprived  as  they 
are  by  the  laws  of  the  State  of  their  personal  liberty,  they 
naturally  become,  in  one  sense,  her  wards,  and  should,  in 
their  helpless  and  suffering  condition,  be  so  regarded. 
Whether  they  occupy  buildings  owned  by  the  State  or  those 
belonging  to  cities  or  counties,  the  State  should  recognize 
her  obligations  to  protect  them,  and  should  see  that  every 
requisite  to  their  proper  care  is  afforded  them. 

PUBLIC    ACCOUNTS. 

The  reports  annually  presented  to  the  English  Parliament 
in  relation  to  the  care  of  the  insane  and  other  dependent 
classes,  embody  a  vast  amount  of  varied  and  detailed  infor- 
mation. The  keeping  of  accounts  and  the  collecting  and 
tabulating  of  statistics  respecting  relief  afforded  these  class- 
es, involve  careful  book-keeping  in  the  charitable  institutions, 
a  considerable  outlay  for  clerical  service,  and  much  labor  on 
the  part  of  public  officials  ;  but  the  practical  advantages  de- 
rived therefrom  by  the  Government  are  so  great  that  the 
work  is  deemed  indispensable. 

The  methods  adopted  by  several  of  the  American  States 
in  preparing  for  legislative  bodies  needful  information  re- 
lating to  the  care  of  the  dependent  classes,  are,  in  some 
respects,  superior  to  those  of  Great  Britain.  The  s\-stcm 
elaborated  by  Mr.  F.  H.  Wines,  Secretary  of  the  Illinois 
State  Board  of  Charities,  is,  with  some  slight  modifications, 
one  of  the  best  of  our  American  methods.  In  many  States 
the  lack  of  a  general  system  of  classifying  and  tabulating 
the  expenditures  of  State  charitable  institutions  is  greatly 
felt,  and  the  subject  is  one  worthy  the  attention  of  legislative 
bodies. 


360  RESUME. 

It  appears  to  me  desirable  that  a  central  Bureau  should 
classify  the  disbursements  of  all  the  institutions,  in  order  to 
apply  a  uniform  rule  in  deciding  between  what  are  ordinary 
and  extraordinary  expenditures,  etc.  It  would  seem  that 
the  Legislature  of  every  State  should  require  each  one  of 
its  State  charitable  institutions  to  furnish  a  central  Board 
or  Bureau  with  an  annual  itemized  statement  of  all  its  re- 
ceipts and  disbursements,  as  also  an  inventory  of  its  supplies 
and  other  property  in  such  form  as  the  central  Bureau  might 
direct,  and  that  this  Bureau  should  be  required  to  classify 
and  tabulate  the  information  furnished  and  present  it  yearly 
in  printed  form,  at  a  specified  date,  to  the  Legislature.  The 
tables  should  be  so  arranged  as  to  be  readily  comparable. 
They  should  give,  in  addition  to  the  financial  statements 
usually  rendered  respecting  the  receipts  and  expenditures 
and  the  number  of  inmates  in  each  institution,  the  quantity 
per  capita  of  each  article  used,  the  per-capita  cost  of  each 
article  consumed,  and  the  average  weekly  per-capita  cost  of 
maintenance,  as  also  the  average  weekly  per-capita  cost  of 
support  of  the  inmates  of  each  class  of  State  charitable 
institutions. 

If  this  system  were  adopted,  the  Legislature  would  be 
enabled  to  judge  more  intelligently  of  the  special  wants  of 
the  several  State  institutions  and  the  standard  of  care  be- 
stowed upon  their  inmates.  The  suspicion  of  extravagance 
which  occasionally,  and  very  naturally,  attaches  to  some  in- 
stitutions in  States  that  have  no  general  system  of  the  kind 
described,  would  perhaps,  be  done  away  with,  while  others 
might  show  an  excellence  of  management  that  would  create 
a  spirit  of  emulation  tending  to  general  improvement.  By 
this  means  faults  in  administration  would  also  be  mani- 
fest and  a  remedy  could  be  applied.  Such  a  plan  would  not 
only  prove  a  satisfaction  to  the  tax-paying  citizen  and  to  the 


SUPER  VISION.  361 

student  of  social  science,  but  would  greatly  aid  and  protect 
boards  of  trustees,  and  oflficials  in  immediate  charge. 

It  is  not  creditable  to  a  State  to  be  unable  to  show  to 
its  own  citizens  the  interior  workings  of  its  charitable  insti- 
tutions and  the  cost  in  detail  of  maintaining  the  inmates.  A 
State  neglecting  to  adopt  a  comprehensive  system  of  keep- 
ing its  accounts  and  classifying  its  expenditures  remains 
ignorant  as  to  whether  it  is  in  advance  of  its  neighbors  or 
behind  them  in  respect  to  the  care  of  its  dependent  classes. 
Besides,  it  is  losing  the  full  benefit  that  might  be  derived 
from  inventions  and  improvements  that  have  been  made  in 
one  of  its  institutions  because  they  are  not  brought  prompt- 
ly and  systematically  to  the  attention  of  all  the  others. 

SUPERVISION. 

In  nearly  all  the  countries  visited  there  exists  some  kind 
of  supervision  by  the  general  government  over  the  insane, 
either  through  boards  of  commissioners,  or  ofificers  appointed 
for  the  purpose.  Among  the  various  methods  that  have 
been  adopted,  those  of  England  and  Scotland  appear  to 
be  the  best.  The  English  system  of  supervision  is,  how- 
ever, cumbersome  and  expensive  to  maintain.  In  the  United 
States  the  care  of  the  dependent  classes  is  so  intimately 
connected  that  some  of  our  State  Boards  have  been  organ- 
ized to  supervise  not  only  lunatics,  but  all  classes  requiring 
public  relief.  The  work  of  these  organizations  has  thus  far 
been  highly  creditable,  and  they  give  promise  of  becoming 
more  useful  with  increased  experience. 

The  success  of  general  supervising  boards  does  not  depend 
so  much  on  the  amount  of  power  they  possess,  as  upon  the 
judicious  exercise  of  the  authority  with  which  they  are 
invested.  This  is  well  illustrated  in  the  policy  of  the  Scotch 
and  English  Lunacy  Boards,  through  which  great  reforms 


362  RESUME.. 

and  wholesome  regulations  have  been  brought  about. 
Both  of  these  bodies,  though  active  and  earnest  in  the 
advocacy  of  humane  methods,  and  watchful  in  maintaining 
a  strict  observance  of  the  statutes  respecting  the  care  and 
treatment  of  the  insane,  nevertheless  have  sought  to  carry 
their  measures  by  moral  suasion  rather  than  by  the  arbitrary 
enforcement  of  the  law.  The  late  Chairman  of  the  English 
Board  said  :  "  I  am  sure  that  the  success  we  have  had  with 
the  county  asylums  has  been  entirely  because  we  have  done 
every  thing  by  persuasion,  by  the  force  of  experience  and 
constant  observation." 

Supervising  State  Boards  should  be  so  constituted  as  to 
be  non-partisan,  and  should  include  members  of  the  medical 
and  legal  professions  and  persons  of  well-known  business 
qualifications.  They  should  be  appointed  for  long  terms. 
A  Board  should  not  be  so  large  as  to  be  unwieldy.  Its 
members  should  have  definite  duties  to  perform,  including 
certain  well-defined  visitations,  and  it  should  have  the  power 
to  employ  competent  deputies,  who  should  be  constantly 
active  in  making  inspections.  The  Board  should  report  an- 
nually to  the  Legislature,  giving  a  full  account  of  its  work, 
the  condition  of  the  classes  under  its  supervision,  with 
suggestions  and  recommendations  for  their  humane  and 
economical  care.  Such  Boards  should  be  vested  with  the 
necessary  statutory  powers  to  protect  fully  the  insane  and 
further  their  interests. 

In  every  lunacy  system  there  should  be  kept  by  the  super- 
vising Board  of  Commissioners  a  registry  of  all  the  insane 
under  official  cognizance,  and  when  a  patient  is  admitted 
to  an  asylum  the  admission  papers  with  the  medical 
certificates  should  be  forwarded  to  the  commissioners. 
These  should  be  accompanied  by  a  statement  from  the 
asylum  superintendent  of  the  mental  and  physical  condition 


SUPERVISION.  363 

of  the  patient.  It  should  be  practicable  for  commissioners 
to  make  transfers  from  one  asylum  to  another,  or  from  asy- 
lum to  family  care.  They  should  also  be  empowered  to 
correct  errors,  to  make  discharges  after  special  examina- 
tions, and  to  prosecute  for  abuse  of  patients.  In  the  for- 
mation of  supervising  Boards,  the  Scotch  system  furnishes 
profitable  suggestions. 


INDEX. 


Aarhus,  asylum  at,  2og 

Accounts,  public,  359 

Acute  Insane,  provision  for,  297 

Admission  of  patients,  in  England, 
27  ;  in  Scotland,  n8  ;  in  Ireland, 
180  ;  in  France,  199  ;  in  Belgium, 
201  ;  in  Prussia,  203  ;  in  Province 
of  Saxony,  281  ;  in  Switzerland,  220  ; 
(Resume),  347 

Air-space,  306 

Alcoholic  stimulants,  342 

Alt-Scherbitz  Provincial  Asylum,  situa- 
tion, central  buildings,  Manor  House, 
cottages,  land,  279  ;  grounds,  memo- 
rial of  Professor  John  Maurice 
Koeppc,  object  of  asylum,  super- 
vision, control,  management,  280  ; 
medical  staff,  officers,  class  of 
patients  received,  admission,  281  ; 
discharge,  release  on  trial,  282  ; 
classification,  rates  charged,  recep- 
tion stations,  observation  stations, 
detention  houses,  administration 
building,  283  ;  hospital,  description 
of  central  institution  buildings, 
284  ;  isolation  rooms,  285  ;  non- 
restraint,  strong  dresses,  attend- 
ants, medical  examination,  286  ; 
villas,  furniture  and  furnishing,  2S7  ; 
hamlet,  two-story  pavilions,  kitchen, 
vehicle  for  carrying  food,  288  ;  heat- 
ing, water,  bucket  system,  farm  build- 
ings, dairy,  brick-yard,  hot-house, 
fish-pond,  orchard,  employment, 
289  ;  excursions,  theatrical  enter- 
tainments, concerts,  dances,  bowl- 
ing, swimming-bath,  correspond- 
ence, 290  ;  visits  by  relatives  and 
others,  a  fundamental  principle  in 
treatment,  291 

America,  early  provision  for  insane  in, 
II  ;  initial  point  of  hospital  treatment 
in,  II  ;  first  State  asylum  in,  12  ; 
establishment  of  hospital  for  insane 
by  Society  of  Friends  in,  12 

Amusements,  47,  54,  57,  63,  67,  74,  82, 
89,  98,  loi,  107,  183,  185,  191,  215, 
223,  228,  234,  290  ;  (Resume),  329 


Andrews,  Dr.  J.  B.,  324 

Arthur's  Seat,  168 

Asylum  at  Jerusalem,  6 

Asylums  for  the  chronic  insane,  304,  305 

Attendants,  49,  51,  56,  65,  79,  93,  143, 
149,  157,  163,  192,  215,  222,  223, 
229,  234,  286  ;  (Resume),  322,  327 

Banstead  Asylum,  object.  Commit- 
tee of  Visitors,  55  ;  situation,  quan- 
tity of  land,  buildings,  medical  staff, 
officers  and  employees,  attendants, 
airing-courts,  56  ;  restraint,  dress, 
tell-tale  clocks,  electric  fire-bells, 
fire-brigade,  general  kitchen,  water 
supply,  employment,  amusements,  li- 
brary, 57  ;  dramatic  entertainments, 
picnic  excursions,  asylum  band, 
dances,  chapel,  cost  of  maintenance. 

Barony  Parochial  Asylum  (Lenzie), 
management,  class  of  patients, 
Lenzie  Act,  situation,  freedom  from 
restraint,  land,  farm  dwellings,  142  ; 
porter's  lodge,  buildings,  grounds, 
officers,  attendants,  dormitories,  143; 
single  rooms,  strongrooms,  infirmary 
wards,  aviary,  144  ;  bath-rooms,  wa- 
ter distriljution,  sewing-rooms,  enter- 
tainment hall,  dances,  asylum  band, 
reading  matter,  dining-hall,  food, 
145  ;  kitchen,  non-restraint,  146  ; 
employment,  tact  in  management, 
farm  stock,  sewerage,  147  ;  laundry, 
dress,  uniforms,  14S  ;  rules  govern- 
ing night  attendants,  149  ;  daily  rou- 
tine, 150  ;  glazed  corridors,  chapel. 
Dr.  Rutherford's  views  respecting 
non-restraint,  151  ;  stimulating  bev- 
erages, milk,  152  ;  Muckroft  Farm, 
Farm  Steading,  Fauldhead,  cost  of 
maintenance,  153 
Bath  and  dressing  rooms,  309 
Belfast  Asylum,  class  of  patients,  184  ; 
chronic  cases,  buildings,  grounds, 
single  rooms,  dormitories,  dining- 
hall,  employment,  airing-courts,  ball- 
playing,  asylum  band,  185 


365 


366 


INDEX. 


Belgium,  reorganization  of  lunacy  sys- 
tem in  1850,  use  of  wooden  cages 
forbidden,  197  ;  boarding  the  insane 
in  families,  200  ;  Lierneux,  popula- 
tion, number  of  insane,  support 
of  pauper  lunatics,  government  and 
municipal  asylums,  private  estab- 
lishments, admission  of  patients,  201  ; 
visitation  and  inspection,  discharge 
of  patients,  202  ;   Gheel  (see  G.). 

Belt  and  leg-chain,  10 

Bethlem  Hospital,  15,  16,  18,  19 

Bevan,  Mrs.  Elizabeth,  159 

Bicetre,  7,  195,  224 

Birmingham  Borough  Asylums  : 

Winson  Green,  situation,  buildings, 
grounds,  management,  103  ;  fur- 
nishings, padded  rooms,  refractory 
wards,  restraint,  seclusion,  em- 
ployment, uniforms,  dress,  104  ; 
airing-courts,  experience  of  an  old 
superintendent,  105  ;  calisthenics, 
singing  classes,  cost  of  mainte- 
nance, 106 
Rubery  Hill,  object,  situation,  104  ; 
cost  of  maintenance,  106 

Blackstone,  17,  355 

Blair,  Dr.  Robert,  153 

Bloomingdale  Asylum,  13 

Boarding-Out,  in  Scotland,  115,  130  ; 
in  Belgium,  200  ;  in  Norway,  206  ; 
(Resume),  352 

Board  of  Control  (Ireland),  175,  178 

Board  of  Guardians  (England),  42 

Boards  of  Governors  (Ireland),  179 

Borough  Muir,  168 

British  specialists,  criticisms  by,  13 

Brookwood  Asylum  (see  Surrey  County 
Asylum). 

Brushfield,  Dr.,  78,  80,  81 

Buildings,  297  ;  objections  to  large 
mixed  asylums,  298  ;  need  of  small 
hospitals  for  the  acute  insane,  299  ; 
plan  of  hospital,  300;  reception  and 
other  cottages,  301  ;  connecting  cor- 
ridors, 302  ;  provision  for  the  chronic 
insane,  303  ;  construction  of  build- 
ings, 305 

Bulckens,  Dr.,  250,  259 

Burgholzli  Cantonal  Asylum,  situation, 
medical  staff,  Ijuildings,  219  ;  admis- 
sion, object,  classification,  rate 
charged  for  pauper  patients,  land, 
airing-courts,  dining-halls,  dormito- 
ries, single  rooms,  220  ;  chapel, 
amusement-hall,  strong  dresses, 
muffs,  refractory  ward,  isolating  cells, 
hot-water  baths,  221  ;  bucket  system, 
attendants,  heating,  employment, 
causes  of  insanity  in  Switzerland,  222 


Case,  Dr.,  61 

Caterham  Metropolitan  Asylum,  object, 
management,  supervision,  situation, 
land,  buildings,  64  ;  single  rooms, 
class  of  patients,  attendants,  cost  of 
maintenance,  infirmary,  65  ;  restraint 
and  seclusion,  padded  rooms,  day- 
rooms,  66  ;  water  supply,  Turkish 
bath,  swimming  bath,  kitchen,  uni- 
forms, dress  of  patients,  asylum 
band,  amusement-hall,  theatricals, 
singing  class,  library,  67  ;  outdoor 
sports,  indoor  games,  walking  par- 
ties, chapel,  accounts,  original  out- 
lay,  68 

Charenton  Asylum,  7,  226  ;  class  of 
patients,  history  of  institution,  build- 
ings, chapel,  the  Seine,  airing-courts, 
226  ;  medical  staff.  Sisters  of  St. 
Augustine,  uniforms,  heating,  dining- 
rooms,  wine,  diet,  227  ;  dormitories, 
hydropathic  treatment,  reading- 
room,  library,  billiard-room,  amuse- 
ment-room, refractory  wards,  seclu- 
sion, 228  ;  restraint,  rates  of  mainte- 
nance, attendants,  single  rooms, 
bric-a-brac,  229 

Chartered  or  Royal  Asylums  (Scotland), 

115. 
Chronic  Insane,  provision  for,  303 
Circulating  Swing,  9 
Clermont  Asylum,   229  ;  situation,  dis- 
tribution  of    patients,   rates   of    pay- 
ment, 230 

Central   Institution,    230  ;    classifica- 
tion, accommodations,  dormitories, 
infirmary,  restraint,  231  ;  isolating 
cells,  restraining  chairs,  camisoles, 
airing-courts,    232  ;   summer  pavil- 
ion, dress,  buildings,  grounds,  233 
Colony  of  Fitz-James,  233  ;  billiard- 
room,     library,     furniture,    attend- 
ants,  dormitories,    Little   Chateau, 
laundry,    234  ;     land,    agriculture, 
235  ;     farm    buildings    and    stock- 
yards, farm  stock,    rabbits,    prizes, 
accommodation  for  farm  laborers, 
sewage  system,  236  ;  employment, 
flouring  mills,  forge  and  machine- 
shop,  cement-mill,  cider-mill,  bak- 
ery, abattoir,  dairy,  237 
Colony  of  Villers,  objects,  open-door 
system,  237  ;   attending  church,  re- 
wards for  work,  237 
Clouston,  Dr.  T.  S.,  158,  313,  324,  330 
Colney  Hatch  Asylum,  35,  45;  situation, 
buildings,  porter's  lodge,  land,  class 
of  ]5atients,  Committee  of  Visitors,  45; 
Victoria   Fund,    interior  decorations, 
single    rooms,     dormitories,     sitting- 


INDEX. 


367 


rooms,  46  ;  amusements,  classifica- 
tion, infirmary,  dining-halls,  employ- 
ment, 47  ;  laundry,  amusement-hall, 
dancing,  dramatic  entertainments, 
airing-courts,  restraint,  48  ;  seclusion, 
padded  rooms,  attendants,  uniforms, 
heating,  ventilation,  chapel,  49  ;  cost 
of  maintenance,  50 

Commission  appointed  by  Royal  College 
of  Physicians,  17 

Commission,  Royal  (Scotland),  appoint- 
ment of,  1855,  investigations  by,  re- 
port of,  112 

Commission,  Royal  (Ireland),  1857, 
appointment  of,  report  of,  175 

Commission  of  Inquiry  (Ireland),  1879, 
recommendations  of,  176 

Commissioners,  1828,  appointed  to  li- 
cense and  visit  establishments  in 
metropolitan  district,  21 

Commissioners  in  Lunacy  (England), 
appointment  of,  powers  of,  24  ;  im- 
mediate jurisdiction  of,  granting 
licenses  by,  26  ;  statement  of  re- 
specting unnecessary  detention,  35  ; 
visitation  by,  37  ;  salaries  of,  expendi- 
tures of,  38  ;  protest  of  against  large 
asylums,  298  ;  views  of  respecting 
employment,  334  ;  respecting  work- 
house care,  354 

Commissioners  in  Lunacy  (Scotland), 
establishment  of  Board  of,  114  ; 
powers  and  duties  of,  117 

Committee  of  House  of  Commons 
(1807),  inquiry  of,  21 

Committee  of  House  of  Commons 
(1877),  inquiry  of  respecting  viola- 
tions of  personal  liberty,  opinions 
of,  33 

Committee  of  Visitors  (England),  by 
whom  appointed,  25  ;  powers  of,  25, 
32 

Conolly,  Dr.,  22,  50,  329 

Conradsberg  Asylum,  class  of  patients, 
buildings,  206  ;  rates  charged  for 
maintenance,  classification,  dress, 
furniture  and  furnishings,  dormito- 
ries, refractory  ward,  single  rooms, 
heating,  women's  work-room,  indus- 
tries, weaving,  spinning,  207  ;  airing- 
courts,  cliapel,  dining-rooms,  food,  208 

Cork  District  Lunatic  Asylum,  situation, 
grounds,  object,  building,  Board  of 
Governors,  medical  staff,  182  ;  house 
staff,  single  rooms,  dormitories,  fire- 
places, dining  and  amusement  hall, 
airing-courts,  ball-playing,  183  ;  land, 
employment,  restraint,  padded  rooms, 
Turkish  liath,  chaplains,  asylum 
band,  184 


County  and  Borough  Asylums  (Eng- 
land), objects  of,  management  of, 
25  ;  cost  of  maintenance  in,  43 

Court  of  Chancery,  17 

Coxe,  Dr.  James,  348 

Crichton,  Dr.,  in 

Crichton  Institute,  ill 

Criminal  Insane,  351 

Criminal  Lunatic  Asylum  (Ireland),  177 

Criminal  Lunatics,  discharge  of,  33 

Cromwell,  i6g 

Dark  Ages,  ignorance  in  the,  4 

Demonology,  5 

Denmark,  lunacy  legislation,  206  ;  asy- 
lum at  Aarhus,  asylum  at  Vording- 
borg,  asylum  for  the  chronic  insane 
at  Viborg,  209  ;  St.  Hans  Hospital 
(see  S.). 

Dietary  and  Dining-rooms,  340 

Discharge,  (England),  31  ;  on  trial,  36; 
(Scotland),  121  ;  of  dangerous  luna- 
tics, 123;  on  trial,  on  probation,  124  ; 
(Ireland),  181  ;  (France),  199  ;  (Bel- 
gium), 200  ;  (Province  of  Saxony), 
282  ;  (Resume),  347 

District  Asylums  (Scotland),  115  ;  (Ire- 
land), 175, 176 

Dix,  Miss,  12,  III 

Donegal  District  Asylum,  situation,  185; 
gateway  lodge,  buildings,  grounds, 
single  rooms,  associated  dormitories, 
open  fires,  restraint,  seclusion,  airing- 
courts,  industries,  186 

Doors,  307 

Dress  and  Clothing,  340 

Dublin,  asylum  at  (see  Richmond  Asy- 
lum). 

Duncan,  Dr.  Andrew,  159 

Eames,  Dr.,  329 

Earle,  Dr.  Pliny,  250 

Edward  II.,  17 

Eg,  asylum  at,  205 

Egyptians,  ancient,  treatment  of  insane 
by,  2 

Employment,  47,  52,  57,  72,  80,  87, 
92,  98,  102,  104,  147,  157,  161,  184, 
185,  186,  188,  191,  206,  207,  210,  216, 
218,  222,  237,  273,  289  ;  (Resume), 
332 

England,  former  treatment  of  the  insane 
in,  Bethlem  Hosjutal,  early  legisla- 
tion, 15  ;  the  insane  wandering  at 
large,  St.  Luke's  Hospital,  inade- 
quate provision,  public  exhibition  of 
the  insane,  16  ;  appointment  of  com- 
mission by  Royal  College  of  Physi- 
cians, estates  of  idiots,  Chancer}^  care, 
17  ;    cruel   treatment   of    the   insane, 


368 


INDEX. 


case  of  Norris,  i8  ;  York  Asylum, 
York  Retreat,  19,  20  ;  inquiry  of  Se- 
lect Committee  of  the  House  of  Com- 
mons, county  and  borough  asylums, 
appointment,  inquiry,  and  report  of 
Metropolitan  Commissioners,  21  ; 
provision  for  the  insane  prior  to  1844, 

22  ;  means  of  restraint.  Act  of  1845, 
erection  of  asylums  made  obligatory, 

23  ;  appointment  and  powers  of  Lun- 
acy Commissioners,  building  asylums 
made  com])ulsory,  24  ;  object  and 
management  of  county  and  borough 
asylums,  25  ;  maltreatment  of  pa- 
tients, licensed  houses,  26  ;  registered 
hospitals,  admission,  27  ;  discharge, 
31  ;  transfer,  investigation  (1877)  by 
Select  Committee  of  House  of  Com- 
mons, 33  ;  testimony  of  I^ord  Shaftes- 
bury, 34  :  complaints  of  unnecessary 
detention,  35  ;  liberation  on  trial,  36  ; 
visitation  by  Commissioners  in  Lu- 
nacy, 37  ;  estimated  cost  of  lunacy 
supervision,  number  and  distribution 
of  lunatics,  38  ;  lunatics  in  work- 
houses, government  grant,  39;  private 
single  patients,  outdoor  pauper  luna- 
tics, 40  ;  metropolitan  district  asy- 
lums. Metropolitan  Asylums  Board, 
Local  Government  Board,  41  ;  trans- 
fer of  insane  to  workhouses,  42  ; 
supervision  of  workhouses,  cost  of 
maintenance  in  county  and  borough 
asylums,  increase  of  pauper  lunatics, 
43  ;  lunatics,  paupers,  population,  44 
Colney  Hatch  Asylum  (see  C.)  ; 
Hanwell  Asylum  (see  H.)  ;  Banstead 
Asylum  (see  B.)  ;  Leavesden  Metro- 
politan Asylum  (see  L.)  ;  Caterham 
Metropolitan  Asylum  (see  C.)  ; 
Sussex  County  Asylum  (see  S.)  ;  Sur- 
rey County  Asylum  (see  S.)  ;  West 
Riding  Asylum,  Wakefield  (see  W.)  ; 
South  Yorkshire  Asylum,  Wadsley 
(see  S.)  ;  I^ancaster  County  Asylum, 
Prestwich,  (see  L.)  ;  Lancaster 
County  Asylum,  Whittingham  (see 
L.)  ;  Birmingham  Borough  Asylums 
(see  B.)  ;   Friends'  Retreat  (see  F.) 

Esquirol,  195,  226,  228,  241,  277 

Fire,  protection  against,  311 

F'ire-places,  307,  310 

Fit/,- lames,  colony  of  (see  Clermont). 

Flodden  '^'ield,  168 

Foundation  Walls,  306 

Foville,  Achille,  200 

F>ance,  cruel  treatment  (jf  the  insane 
in  the  latter  part  of  the  i8th  and 
early  part  of  the  19th  centuries,  195  ; 


present  provision  for  the  insane,  197  ; 
establishment  of  asylums  made  obli- 
gatory, inspection  of  public  and  pri- 
vate asylums,  supervision  of  public 
asylums,  198  ;  official  visitation  of 
asylums,  admission,  discharge,  199  ; 
right  of  reclamation,  opinion  of 
Achille  Foville,  200  ;  La  Salpetriere, 
(see  S.)  ;  Asylum  of  Ste.  Anne  (see 
S.)  ;  Asylum  at  Charenton  (see  C.)  ; 
Clermont  en  Oise  (see  C), 

Francis,  Dr.  Lloyd,  335 

Frankford,  hospital  at,  12 

F"raser,  Dr.,  139 

Freedom,  greater,  317 

Friedrichsberg  Asylum,  government, 
porter's  lodge,  Pensionnat,  principal 
building,  park  and  cultivated 
grounds,  class  of  patients,  212  ; 
variety  of  accommodation,  routine 
of  meals,  beer,  smoking-room,  bath- 
rooms, 213  ;  library,  dining-rooms, 
dormitories,  214  ;  clothing,  valua- 
bles, letters,  heating,  lighting,  bowl- 
ing-green, l)illiard-room,  music  hall, 
chapel,  attendants,  salaries,  215  ; 
solitary  rooms,  refractory  wards,  as- 
phalt floors,  chronic  insane,  two-story 
buildings,  yards,  non-restraint,  em- 
ployment, farm  stock,  216  ;  farm 
buildings,  classification,  217 

Friends'  Retreat,  19,  20,  22,  106  ;  non- 
restraint,  William  Tuke,  Society  of 
Friends,  106  ;  situation,  grounds, 
management,  income,  buildings.  The 
Lodge,  Bellevue  House,  villa  resid- 
ence, interior,  sitting-room,  religious 
services,  association  rooms,  lectures 
and  entertainments,  107 ;  rates  of 
payment,  cost  of  support,  padded 
rooms,  strong  garments,  seaside  re- 
sort,  108 

Friends'  Retreat,  Penn.,  351 

Furnishing  and  Decoration,  312 

Gaustad  Asylum,  204  ;  situation,  build- 
ings, heating,  dormitories,  airing- 
courts,  rooms  for  the  refractory, 
douche,  205  ;  padded  rooms,  strong 
dresses,  employment,  206 

George  II.,  15 

George  III.,  attacked  by  insanity,  16 

Germany,  "mad-houses"  in  (1803), 
194  ;  curative  treatment  in,  197  ; 
asylum  care,  family  care,  public  and 
private  asylums,  o]5en  asylums  (C^cvz^ 
Anstalten),  203  ;  Friedrichsberg  Asy- 
lum (see  F.)  ;  Provincial  Asylum 
Halle  (see  H.)  ;  Provincial  Asylum, 
Alt-Scherbitz  (see  A.). 


INDEX. 


369 


Gheel,  3,  204  ;  town  of,  239  ;  Church 
of  St.  Dymphna,  240  ;  religious  cere- 
monies, 241  ;  legend  of  St.  Dymphna, 
242  ;  commune  of  Gheel,  243  ;  gen- 
eral description  of,  244  ;  the  In- 
firmary, 245  ;  supervision  and  medi- 
cal visitation  of  the  insane,  246  ; 
inspectors,  description  of  Infirm- 
ary, 247  ;  means  of  restraint,  Hotes 
and  Nourriciers,  249  ;  treatment  of 
the  insane  prior  to  1851,  250;  class 
of  patients,  rates  of  payment,  251  ; 
inspection  of  town  dwellings,  253  ; 
inspection  of  cottages  in  the  coun- 
try, 263  ;  regulations  regarding 
labor,  etc.,  rewards  for  work, 
273  ;  advantages  and  disadvantages, 
274 

Gifts  of  land,  296 

Glen-na-galt,  3 

Gloucester,  22 

Government  Grant  (England)  39  ; 
(Scotland),   127  ;  (Ireland),  177  ;  35S 

Greek  Medical  School,  2 

Grounds,  314 

Halle  Provincial  Asylum,  class  of  pa- 
tients, government,  location,  build- 
ings, land,  employment,  improve- 
ments, sewerage,  gas  and  water  pipes, 
218  ;  farm  cottage,  infirmary,  sani- 
tary arrangements,  unlocked  doors, 
associated  dormitories,  single  rooms, 
219 

Hamburg,  asylum  near  (see  Friedrichs- 
berg) 

Hanwell  Asylum, class  of  patients,  situa- 
tion, buildings,  land,  50  ;  hospital 
for  infectious  diseases,  attendants, 
uniforms,  ventilation,  thermometers, 
proportion  of  single  rooms,  decora- 
tions, furniture,  51  ;  employment, 
52  ;  restraint,  strong  dresses,  padded 
rooms,  53  ;  seclusion,  airing-courts, 
clothing,  amusement-hall,  dancing 
parties,  outdoor  games,  picnics, 
reading  matter,  religious  services, 
cost  of  maintenance,  54 

Haywards  Heath,  asylum  at  (see  ^Sussex 
County  Asylum) 

Henley,  Inspector,  42,  354 

Henry  VIII.,  15 

Hill,  Dr.  R.  Gardiner,  iS,  22,  no 

Holy  Wells,  3 

Hospice  St.  Vincent  de  Paul,  17S 

Hospitals,  299,  304 

Hotel  Dieu,  196 

Houses  of  Industry  (Ireland),  174 

Idiot,  definition  of  term,  17 


Infirmary  Accommodation,  307 
Insane,  The,  need  of  public  provision 
for,  I  ;  treatment  of  by  ancient 
Egyptians,  supposed  to  be  possessed 
by  demons,  2  ;  provision  for  by  Mo- 
hammedans, provision  for  and  treat- 
ment of  in  Spain,  6  ;  exhibited  in 
cages,  6,  16  ;  cruel  treatment  of,  2, 
6,  18,  no,  173,  194,  195 
Insanity,  in  the  Middle  Ages,  2  ;  strange 

devices  for  treatment  of,  8 
Inspectors  (Ireland),  17S,  179 
Ireland,  Dean  Swift,  St.  Patrick's  Hos- 
pital, neglect  of  the  insane,  172  ; 
cruel  treatment,  lack  of  asylum  ac- 
commodation, 173  ;  governmental  in- 
quiry, 18 10,  asylum  built  in  Dublin, 
Houses  of  Industry,  successive  Parlia- 
mentary inquiries.  Act  of  1821,  legal 
status  of  the  insane  prior  to  1821, 
provisions  of  the  Act  of  1821,  forma- 
tion of  districts,  174  ;  establishment 
of  Board  of  Control,  asylums  built, 
government  loan,  expenditures,  ap- 
pointment of  Royal  Commission 
1857,  report  of  same,  175  ;  recom- ■ 
mendations  of  Commission  of  Inquiry 
1879,  lunatics  at  large,  population, 
number  and  distribution  of  lunatics, 
176  ;  cost  of  maintenance  in  district 
asylums,  government  grant,  cost  of 
maintenance  in  poorhouses,  inade- 
quate provision  for  the  chronic  insane, 
government  of  lunatics  in  poorhouses. 
Local  Government  Board,  177  ;  con- 
dition of  poorhouses,  private  asylums 
and  licensed  establishments,  Board 
of  Control,  Inspectors,  17S  ;  visitation 
by  Inspectors  and  reports  of,  Boards 
of  Governors,  appointment  of  medical 
officers,  granting  licenses,  179;  dan- 
gerous lunatics,  admission,  180  ;  dis- 
charge, insufficiency  of  land,  iSi  ; 
industries,  182  ;  Cork  District  Asy- 
lum (see  C.)  ;  Belfast  Asylum  (see 
B.)  ;  Donegal  District  Asylum  (see 
D.)  ;  Richmond  District  Asylum 
(see  R.) 

James  IV.,  168 

James  V.,  169 

James  VI.  of  Scotland,  5 

Jerusalem,  asylum  at,  6 

Justices  (England),  required  to  provide 
asylums,  23,  24  ;  required  to  appoint 
committees  to  build  asylums  and 
committees  to  manage  same,  25  ; 
empowered  to  grant  licenses,  26  ;  re- 
quired to  appoint  Visitors  to  licensed 
houses,  27  ;   order  of,  28 


370 


INDEX. 


Labitte,  Dr.  George,  230 

Labitte,  Dr.  Gustave,  230,  236 

Lalor,  Dr.  Joseph,  106,  187,  188,  193 

Lancaster  County,  population,  paupers, 
pauper  lunatics,  94 

Lancaster  County  Asylum  (Prestwich), 
situation,  buildings,  94 ;  porter's 
lodge,  dress  of  patients,  annexe,  in- 
firmary wards,  convalescent  wards, 
95  ;  ward  for  refractory  female  pa- 
tients, single  rooms,  heating,  dormi- 
tory, padcled  rooms,  seclusion,  96  ; 
dining-halls,  entertainment  hall,  use 
of  beer,  97  ;  land,  employment,  farm- 
house, detached  cottage,  walking 
parties,  dancing,  theatrical  enter- 
tainments, chapel,  causes  of  insanity 
of  inmates,  98 

Lancaster  County  Asylum  (Whitting- 
ham),  situation,  buildings,  land,  an- 
nexe, dormitories,  thermometers, 
100  ;  day-rooms,  padded  rooms,  non- 
restraint,  strong  dresses,  wet  packing, 
dining  and  amusement  hall,  airing- 
courts,  walking  parties,  outdoor 
recreation,  theatricals,  loi  ;  concerts, 
employment,  washing  by  hand,  cost 
of  maintenance,  heating,  102  ;  relig- 
ious services,  103 

Land  for  institutions  for  the  insane,  294 

Lawson,  Dr.,  140 

Leavesden  Metropolitan  Asylum,  situa- 
tion, outlay  per  capita,  management, 
58  ;  officers  and  emjiloyees,  buildings, 
conservatories,  59  ;  heating,  descrip- 
tion of  interior,  electric  clocks,  60  ; 
hydropathic  treatment,  6r  ;  laundry, 
water  supply,  sewage,  restraint,  pad- 
ded rooms,  seclusion,  recreation  hall, 
62  ;  amusements,  costume  ball,  walk- 
ing parties,  dress  of  patients,  chapel, 
library,  63  ;  cost  of  maintenance, 
64 

I^enzie,  asylum  at  (see  I5arony  Parochial 
Asylum) 

I^etterkenny,  asylum  at  (see  Donegal 
Asylum) 

Letters,  290,  344 

Ley,  Dr.,  95,  98,  326 

licensed  Plouses  (England),  26  ;  Visit- 
ors of,  medical  attendance  at,  27  ; 
order  for  admission  to,  notice  of  ad- 
mission to,  29,  30  ;  (Scotland),  con- 
dition of  insane  in,  113  ;  number  of, 
115  ;  rredical  visitation  of,  126  ;  (Le- 
land),  178,  179  ;  (France),  establish- 
ment of,  198  ;  (Belgium),  establish- 
ment of,  201 

Lierneux,  insane  colony  at,  201 

Lincoln  Asylum,  22 


Local  Government  Board  (England), 
supervision  by,  salaries  of  Inspectors 
of,  38  ;  central  authority  in  poor-law 
matters,  reports  submitted  to,  43 

Local  Government  Board  (Ireland),  177 

Local  or  District  Care,  356 

Location,  293 

Lochmanur,  3 

Loch  Maree,  well  of,  4 

Lord  Chancellor,  appointments  by,  38 

Lunacy  Legislation  (England),  r744, 
15  ;  1774,  17  ;  1808,  1828,  1832, 1842, 
21  ;  Act  of  1845,  23,  34,  36  ;  Act  of 
1853,  24,  30,  31  ;  Act  of  1862,  30, 
37,  42  ;  1868,  42  ;  (Scotland),  1815, 
1829,  1841,  HI  ;  Act  of  1857,  114; 
1862, 1866, 120, 124  ;  1880,  120  ;  (Ire- 
land), 1821,  174  ;  (Belgium),  1850, 
197  ;  (Norway),  (Sweden),  (Den- 
mark), 206 

Lunatic,  definition  of  term,  17,  24 

Lunatics,  estates  of,  17 

Macdonald,  Dr.  A.  E.,  309 
MacDonald,  Dr.  Carlos  F.,  352 
McLean  Asylum,  12,  351 
Mary  Queen  of  Scots,  168 
Masters  in  Lunacy,  salaries  of,  38 
Medical  Certificates,  27,  28,  29,  30,  31, 
37,  119,  120,  122,  123,  129,  179,  180, 
199,  201,  203,  281 
Medical  Officers,  321 
Menstone,  asylum  at,  83,  302 
Metropolitan  Asylums  Board,  41,  58 
Metropolitan  Commissioners  in  Luna- 
cy, appointment  of,  report  of,  21 
Metropolitan  District  Asylums,  41 
Middle  Ages,  insanity  in,  2  ;  practice  of 
medicine  bymonks  in, 4;  asylums  in,  6 
Middlesex    County,    area,    population, 

paupers,  45 
Mid-Lothian  and  Peebles  District  Asy- 
lum,   situation,    management,    land, 
buildings,  grounds,  cottages,  private 
patients,  rates  for  maintenance,  dor- 
mitories, 154  ;  single  rooms,  heating, 
ventilation,  lighting,  day-rooms,  155  ; 
billiards,    lavatory,   infirmary  wards, 
halls  and  corridors,  dining-hall,  food, 
chapel,    156  ;    padded    rooms,    non- 
restraint,     attendants,     employment, 
dress,  157 
Mitchell,  Dr.,  93,  339 
Mitchell,  Dr.,  Commissioner,  121 
Mohammedans,  provision  for  insane  by, 

6 
Monks  at  Saragossa,  6 
Morningside,  asylum  at  (see  Royal  Ed- 
inburgh Asylum) 
Murray's  Royal  Asylum,  ill 


INDEX. 


371 


New  York,  State  provision  for  insane 
in,  12 

New  York  Hospital,  12 

Night  Attendants,  rules  governing, 
149 

Night  Service,  327 

Non-Restraint,  22,  50,  78,  89,  lOl,  105, 
106,  146,  151,  157,  216,  286  ;  (Re- 
sume), 319 

Norman,  Dr.  ConoUy,  193 

Norris,  cruel  treatment  of,  18 

Norway,  government  of  State  asylums, 
government  of  local  asylums,  board- 
ing-out, State  wards,  lunacy  legisla- 
tion, 206  ;   Gaustad  Asylum  (see  G.) 

Nursery  for  Plants,  80,  315 

Orderly  Arrangement,  315 
Outdoor  Pauper  Lunatics,  40 

Padded  Rooms,  49,  53,  62,  66,  71,  86, 
91,  96,  loi,  104,  108,  157,  163,  184, 
188,  206,  225  ;  (Resume),  319 

Paetz,  Dr.,  281,  286,  290 

Parigot,   Dr.,  250 

Paris,  7  ;  early  treatment  of  insane  in, 
195  ;  asylums  at,  222,  224,  226 

Pariset,  195 

Parliamentary  Investigations,  21 

Parochial  Asylums  (Scotland),  115 

Patients,  law  respecting  maltreatment 
of,  26 

Pauper,  definition  of  term,  44 

Pauper  Lunatics,  increase  of,  43 

Peeters,  Dr.,  240,  246 

Pennsylvania,  first  hospital  for  insane 
in,  II 

Pensions,  71,  84,  325 

Perceval,  Secretary,  statements  of  re- 
specting admission  to  asylums,  28  ; 
undue  detention,  32  ;  outdoor  pauper 
lunatics,  40 

Petit,  Dr.  Joseph,  186,  318 

Pinel,  7,  19,  22.,  195,  196,  224 

Pipes,  supply  and  waste,  308 

Poorhouses,  (Scotland),  115,  127  ;  (Ire- 
land), 177  ;  condition  of,  178  ;  (Re- 
sume), 354 

Post-mortem  Examinations,  90,  93  ; 
(Resume),  346 

Prestwich,  asylum  at  (see  Lancaster 
County  Asylum) 

Private  Asylums  (Scotland),  115  ;  (Ire- 
land), 178 

Private  Dwellings  (Scotland),  insane 
in,  115 

Private  Single  Patients,  40 

Prussia,  admission  to  asylums  in,  pri- 
vate asylums  in,  203  ;  maintenance 
of  the  incurable  pauper  insane,  dan- 


gerous cases,  204  ;  Provincial  Asylum 
(see  Halle)  ;  Provincial  Asylum  (see 
Alt-Scherbitz) 

Psychology,  study  by  ancient  Greeks 
of,  4 

Public  Accounts,  359 

Rayner,  Dr.,  51,  53,  298 

Reforms  in  continental  countries,  196 

Registered  hospitals,  27  ;  medical  at- 
tendance at,  27 

Religious  Exercises,  328 

Remuneration,  72,  81,  237,  273  ;  (Re- 
sume), 338 

Restraint,  23,  48,  53,  57,  62,  66,  72, 
163,  184,  186,  225,  229,  231,  249 

Resume,  293  ;  Location,  293  ;  Build- 
ings, 297  ;  Furnishing  and  Decora- 
tion, 312  ;  Grounds,  314  ;  Orderly 
Arrangement,  315  ;  Sewage,  316  ; 
Greater  Freedom,  317  ;  Non-Re- 
straint, 319  ;  Medical  Officers,  321  ; 
Attendants,  322  ;  Night  Service, 
327  ;  Religious  Exercises,  328  ; 
Amusements,  329  ;  Employment, 
332  ;  Remuneration,  338  ;  Dress 
and  Clothing,  340  ;  Dietary  and 
Dining-rooms,  340  ;  Alcoholic  Stimu- 
lants, 342  ;  Social  Distinctions,  342  ; 
Visitation,  343  ;  Letters,  344  ;  Post- 
mortem Examinations,  346  ;  Admis- 
sion and  Discharge,  347  ;  Voluntary 
Patients,  350  ;  Summer  Resorts, 
351  ;  Criminal  Insane,  351  ;  Board- 
ing-out, 352  ;  Poorhouses,  354  ;  Lo- 
cal or  District  Care,  356  ;  State 
Wards,  357  ;  Public  Accounts,  359  ; 
Supervision,   361 

Retreat,  The,    178 

Rheinau,  asylum  at,  220 

Richmond  District  Asylum,  medical 
staff,  attendants,  grounds,  building, 
dining-hall,  food,  1S7  ;  associated 
dormitories,  padded  rooms,  day- 
rooms,  employment,  school  system, 
188  ;  laundry,  190  ;  table  showing 
employments,  amusements,  walking 
parties,  igi  ;  seclusion,  dress,  at- 
tendants, salaries,  192  ;  churches, 
abolishment  of  airing-courts,  193. 

Riel,  194 

RcEskilde  Fjord,  209 

Ross,  Captain  David,  109 

Rotvold,  asylum  at,  205 

Royal  College  of  Physicians,  17 

Royal  Edinburgh  Asylum,  situation, 
management,  rates  for  maintenance, 
charity  fund,  158  ;  West  House, 
grounds,  cricket  club,  food,  ale,  din- 
ing-halls,  159  ;  general  kitchen,  diet 


372 


INDEX. 


kitchens,  recreation  hall,  heating, 
i6o  ;  shoe-house,  employment, 
printing-office,  i6i  ;  Mornhigside 
Mirror,  laundry,  dormitories,  single 
rooms,  open-door  system,  airing- 
courts  abolished,  162  ;  restraint, 
seclusion,  padded  rooms,  trained 
attendants,  163  ;  seaside  resort.  East 
House,  furniture  and  furnishings, 
open  fires,  billiards,  reading-rooms, 
books,  164  ;  additions  and  improve- 
ments, 165  ;  cottage  for  female  pa- 
tients, Myreside  Cottage,  167  ;  Craig 
House,  sycamores,  extended  views, 
seat  of  the  Carmichaels,  16S  ;  fur- 
niture and  furnishings,  dining-room, 
169  ;  drawing-rooms,  ornamental 
grounds,  class  of  patients  received, 
freedom  from  restraint,  convalescing 
patients,  170 

Rush,  Dr.,  II 

Rutherford,  Dr.,  146,  151,  152,  153 

St.  Andrew's  Hospital,  335 

St.  Anne  Asylum,  situation,  buildings, 
object,  medical  staff,  224  ;  Sisters  of 
St.  Joseph,  day  servants,  refractory 
wards,  isolating  cells,  restraining 
chairs,  padded  rooms,  airing-courts, 
roofed  galleries,  heating,  225  ;  hy- 
dropathic treatment,  226 

St.  Dymphna,  3  ;    legend  of,  242 

St.  Fillan,  wells  of,  4 

St.  Hans  Hospital,  near  Roeskilde, 
208  ;  class  of  patients,  supervision, 
classification,  buildings,  grounds, 
Roeskilde  Fjord,  single  rooms,  asso- 
ciated dormitories,  20g  ;  seclusion, 
dining-halls,  kitchens,  food  wagons, 
chapel,  billiard-room,  bowling-alley, 
reading  matter,  employment,  knit- 
ting, 210  ;  asylum  waste,  beach 
bathing,  211 

St.  Luke's  Hospital,  16,  346 

St.  Maree,  well  of,  4 

St.  Nun's  Pool,  3 

St.  Patrick's  Hospital,  172,  178 

St.  Winifred,  well  of,  3 

Salpctricre,  8,  196,  222  ;  object,  build- 
ings, class  of  patients,  school,  222  ; 
attendants,  cottages,  dormitories, 
cells,         douche,  entertainments, 

kitchen,  223  ;  wine,  grapes,  dining- 
hall,  Pinel,  liicctre,  224 

Sanborn,  F.  B.,  346 

vSaragossa,  monks  at,  6 

Schools,  74,  106,  1 88,  223 

Scotland,  establishment  of  present 
I^unacy  System,  superstitions,  witch- 
craft, sentenced  to  death   for  witch- 


craft, 109  ;  imprisonment  at  Inver- 
ness, inadequate  provision,  private 
aid.  Royal  Edinburgh  Asylum,  no  ; 
Murray's  Royal  Asylum,  Crichton 
Institute,  chartered  or  royal  asylums, 
government  aid,  lunacy  legislation 
in  1815,  1829,  1841,  p.  Ill  ;  ap- 
pointment of  Royal  Commission 
in  1855,  investigation  by  same,  re- 
port of,  112  :  recommendations  of 
Commission,  important  legislation  of 
1857,  creation  of  Board  of  Lunacy, 
present  provision  for  the  insane,  114  ; 
royal  asylums,  district  asylums, 
parochial  asylums,  lunatic  wards  of 
poorhouses,  private  asylums,  insane 
in  private  dwellings,  115  ;  desirable 
reforms.  General  Board  of  Commis- 
sioners in  Lunacy,  116  ;  Deputy  Com- 
missioners, powers  and  duties  of  the 
Lunacy  Board,  117  ;  admission  of 
patients,  118  ;  care  of  property  of 
the  insane,  voluntary  patients,  120  ; 
discharge  of  jjatients,  121  ;  limita- 
tion of  sheriff's  order,  122  ;  danger- 
ous lunatics,  123  ;  liberation  on  trial, 
probationary  discharge,  124  ;  pen- 
alty for  maltreatment  of  patients, 
medical  attendance  in  licensed  es- 
tablishments, 125  ;  proportion  of  in- 
sane to  population,  increase  of  the 
insane,  distribution  of  the  insane, 
how  maintained,  cost  of  mainte- 
nance, 126  ;  government  grant, 
poorhouse  care,  exposition  of 
Lunacy  System,  127  ;  boarding-out, 
130  ;  correspondence,  132  ;  rates  for 
boarding-out,  133  ;  inspection  of  in- 
sane in  private  dwellings,  134  ; 
Barony  Parochial  Asylum  (see  B.)  ; 
Mid-Lothian  and  Peebles  District 
Asylum  (see  M.)  ;  Royal  Edinburgh 
Asylum  (see  R.) 

.Scott,  Hon.  Francis,  298 

Scott,  Sir  Walter,  4,  109,  168 

Seclusion,  49,  62,  66,  72,  78,  89,  96, 
104,  163,  192,  210,  216,  221,  225, 
228,  232 

Sewage,  316 

Sewers,  308 

Shaftesbury,  Earl  of,  testimony  of  relat- 
ing to  abuses  in  asylums,  22  ;  state- 
ment of  respecting  discharge,  34;  298, 
321,  344,  362 

Shakespeare,  16 

Sibbald,  Dr.,  127,  131 

Sites  for  institutions  for  the  insane,  293 

Smith,  Dr.  Stephen,  324 

Social  Distinctions,  342 

Society  of  Friends,  12,  19,  20,  106,  178 


INDEX. 


373 


South  Yorkshire  Asylum,  situation, 
buildings,  porter's  lodge,  church, 
greenhouse,  day- rooms,  90  ;  men's 
infirmary,  refractory  wards,  strong 
rooms,  padded  rooms,  heating,  91  ; 
bathing  arrangements,  food,  kitchen, 
bakery,  brewery,  beer,  laundry, 
water  supply,  employment,  92  ; 
land,  farm  cottages,  hospital  accom- 
modation, post-mortem  examina- 
tions, attendants,  uniforms,  airing- 
courts,  93  ;  dining  and  recreation 
hall,  library,  chronic  cases,  cost  of 
maintenance,  94 

Spain,  provision  for  insane  in,  treat- 
ment of  insane  in.  6 

Spiritual  Agencies,  3 

State  Aid,  39,  127,  177,  357,  358 

State  Provision  for  the  Insane,  12 

State  Wards,  357 

Steenberg,  Dr.,  211 

Stewart  Institution,  178 

Summer  Resorts,  351 

Superstitions,  4,  log 

Supervision,  301 

Surrey  County,  population,  paupers, 
pauper  lunatics,   75 

Surrey  Count)  Asylum  (Brookwood), 
management,  situation,  buildings, 
75  ;  interior  decorations,  oining- 
rooms,  heating  and  ventilation, 
kitchens,  room  for  new  arrivals,  day- 
rooms  dormitories,  76  ;  temperature, 
single  rooms,  bath-room,  77  ;  cot- 
tage hospital,  religious  services,  cost 
of  maintenance,  non-restraint,  seclu- 
sion, 78  ;  padded  rooms,  classifica- 
tion, uniforms,  attendants,  salaries, 
79  ;  land,  employment,  nursery,  con- 
servatory. So  ;  washing  by  hand, 
remuneration,  8t  ;  recreation  and 
amusement,  recreation  hall,  fancy- 
dress  balls,  musical  meetings,  print- 
ing, library,  82 

Sussex  County,  population,  paupers, 
pauper  lunatics,   69 

Sussex  County  Asylum  (Haywards 
Heath),  opening,  management,  situa- 
tion, ornamental  grounds,  quantity 
of  land,  class  of  patients,  buildings, 
6g  ;  dormitories,  wards  for  better 
class  female  patients,  infirmary  ward, 
suicidal  and  epileptic  dormitories, 
70  :  padded  rooms,  detached  hos- 
pital, dress  of  patients,  uniforms, 
wages,  pension,  kitchen,  dining-room 
for  female  patients,  71  ;  beer,  dietary, 
rewards  for  work,  water  supply,  fire- 
hose, sewerage,  wet  and  dry  packing, 
locked    dresses,     seclusion,    employ- 


ment,   72  ;    skilled    artisans,    officers 
and  employees,  cost  of  maintenance, 
reading  matter,  73  ,  school,  religious 
services,  walking  parties,  drives,  pic- 
nic     excursions,       outdoor      games, 
amusement  hall,  theatricals,  concerts, 
fancy-dress  ball,  rules,  74 
Sweden,   lunacy  legislation,   206  ;  con- 
trol  of    asylums,    208  ;    Conradsberg 
Asylum  (see  C). 
Swift.  Dean,  172.  174,   17S 
Swimming  Baths,  67,  211,  290,  309 
Switzerland,  Burgholzli  Cantonal  Asy- 
lum (See  B.) 

Thermometers,  311 
Training  Schools,  324 
Transfers,  33 
Tuke,  Dr.  Batty,  33 r 
Tuke,  Dr.  D.   Hack,  342 
Tuke,  William,  19,  22,  106 

United  States,  progress  of  reform  in. 
13 

Valley  of  Lunatics,  3 

Ventilation,  310 

Viborg,  asylum  at,  209 

Vienna,  early  asylum  at,  197 

\'illers  (see  Clermont). 

Virginia,  first  asylum  in,  12 

Visitation,  343 

Visitors  of  Chancery  patients,  38 

Voluntary     Patients    (Scotland),     120  ; 

(Resume),  350 
Vordingborg.  asylum  at,  209 

Wadsley  (see  South  Yorkshire  Asylum) 

Wakefield  (see  West  Riding  Asylum) 

Wallis,  Dr.,  102,  324 

West  Riding,  population,  paupers, 
pauper   lunatics,    83 

West  Riding  Asylum,  buildings,  land, 
medical  officers  and  attendants,  83  ; 
salaries,  uniforms,  pension,  day- 
room,  dress,  dormitory,  84  ;  strong 
dresses,  locked  boots,  refractory  ward, 
bath-room,  healing,  building  for  con- 
valescing patients,  &5  ;  open  fires, 
day-rooms,  conservatory,  single 
rooms,  strong  rooms,  padded  room, 
fire-brigade,  S6  ;  dining-room  and 
recreation  hall,  food,  general  kitchen, 
employment,  weaving,  tailoring,  S7  ; 
book-bindery,  laundry,  88  ;  gas, 
water  supply,  sewerage,  recreation, 
religious  exercises,  entertainment, 
seclusion,  non-restraint,  S9  ;  post- 
mortem examinations,  cost  of  main- 
tenance, 90 


374 


INDEX. 


White  House  Asylum  (Bethnal  Green), 

abuses  in,  23 
Whittier,  4 
Whittingham    (see     Lancaster    County 

Asylum) 
Willard  Asylum,  295 
Williams,  Ur. ,  333 
Williamsburg,  asylum  at,  12 
Windows,  307 
Wines,  F.  H.,  359 
Witchcraft,  5,  109 


Woodilee  (see    Barony  Parochial  Asy- 
lum) 
Workhouses,  lunatics  in,  42,  354 
Workshops,  308 

York,  Friends'  Retreat  at,  106 
York  Asylum,  19  ;  abuses  in,  20 
Yorkshire,  population,  paupers,  pauper 
lunatics,  83 

Zurich,  asylun\  near,  219 


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